Objective To explore risk factors of lymph node metastasis (LNM) in T1 rectal cancer. Methods The retrospective case-control study was conducted. The clinicopathologic data of 247 patients with T1 rectal cancer underwent radical resection were analyzed in the pathological database of the West China Hospital from January 2000 to December 2016, including the tumor size (maximum diameter), gross type, differentiation degree, histological type, lymph vascular infiltration, perineural infiltration, and carcinoma nodule. The univariate analysis and multivariate analysis were done using the Chi-square test and logistic regression model, respectively. Results The rate of LNM in the patients with T1 rectal cancer was 8.50% (21/247). No lymph metastasis was found in the well differentiated T1 rectal cancer. The results of the univariate analysis showed that the differentiation degree, histological type, and carcinoma nodule were related to the LNM in the T1 rectal cancer (P<0.050). The results of the multivariate analysis revealed that the poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule were the independent risk factors of the LNM in the T1 rectal cancer (OR=9.75, P=0.006; OR=5.98, P=0.042; OR=8.33, P=0.017; OR=10.87, P=0.026). Conclusion In this large population dataset, poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule are risk factors of LNM in T1 rectal cancer.
Objective To investigate the proportions of CD4+ T cells, CD8+ T cells, and mutant of p53 gene in the microenvironment of breast infiltrating ductal carcinoma, and to explore its’ correlation with prognosis of breast infiltrating ductal carcinoma. Methods Eighty-five cases of breast infiltrating ductal carcinoma were collected who underwent surgery in the 371st Central Hospital of Peoples’ Liberation Army from 2010 to 2012, and then detected the proportion of CD4+ T cells and CD8+ T cells, ratio of CD4+ T cells to CD8+ T cells, and mutant of p53 gene in the cancer tissues with immunohistochemistry. Comparison between the sentinel lymph node metastasis group and non-sentinel lymph node metastasis group, mutant of p53 gene group and non-mutant of p53 gene group on the proportions of CD4+ T cells, CD8+ T cells, and ratio of CD4+ T cells to CD8+ T cells were performed, as well as the relationship between proportion of CD8+ T cells/mutant of p53 gene and prognosis of breast infiltrating ductal carcinoma. Results ① The relationship between proportion of CD4+ T cells/proportion of CD8+ T cells/ratio of CD4+ T cells to CD8+ T cells and situation of sentinel lymph node metastasis: at cluster, compared with the sentinel lymph node metastasis group, the proportion of CD8+ T cells was lower in the non-sentinel lymph node metastasis group (P<0.05), but there was no significant difference on the proportion of CD4+ T cells and ratio of CD4+ T cells to CD8+ T cells (P>0.05); at stroma, compared with the sentinel lymph node metastasis group, the proportions of CD4+ T cells and CD8+ T cells were lower, but the ratio of CD4+ T cells to CD8+ T cells was higher in the non-sentinel lymph node metastasis group (P<0.05). ② The relationship between proportion of CD4+ T cells/proportion of CD8+ T cells/ratio of CD4+ T cells to CD8+ T cells and mutant of p53 gene: both at the cluster and stroma, compared with the mutant of p53 gene group, the proportions of CD4+ T cells and CD8+ T cells were lower, but the ratio of CD4+ T cells to CD8+ T cells was higher in the non-mutant of p53 gene group (P<0.05). ③ The relationship between proportion of CD8+ T cells/mutant of p53 gene and prognosis of breast infiltrating ductal carcinoma: the prognosis was worse in patients with high degree of infiltration of CD8+ T cells and mutant of p53 gene than those patients with low degree of infiltration of CD8+ T cells and non-mutant of p53 gene (P<0.05). Conclusions The proportions of CD4+ T cells and CD8+ T cells, and ratio of CD4+ T cells to CD8+ T cells are associated with the situation of sentinel lymph node metastasis and mutant of p53 gene, and the degree of infiltration of CD8+ T cells and mutant of p53 gene are associated with the prognosis of breast infiltrating ductal carcinoma.
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 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 predict the probability of lymph node metastasis after thoracoscopic surgery in patients with lung adenocarcinoma based on nomogram. MethodsWe analyzed the clinical data of the patients with lung adenocarcinoma treated in the department of thoracic surgery of our hospital from June 2018 to May 2021. The patients were randomly divided into a training group and a validation group. The variables that may affect the lymph node metastasis of lung adenocarcinoma were screened out by univariate logistic regression, and then the clinical prediction model was constructed by multivariate logistic regression. The nomogram was used to show the model visually, the receiver operating characteristic (ROC) curve, calibration curve and clinical decision curve to evaluate the calibration degree and practicability of the model. ResultsFinally 249 patients were collected, including 117 males aged 53.15±13.95 years and 132 females aged 47.36±13.10 years. There were 180 patients in the training group, and 69 patients in the validation group. There was a significant correlation between the 6 clinicopathological characteristics and lymph node metastasis of lung adenocarcinoma in the univariate logistic regression. The area under the ROC curve in the training group was 0.863, suggesting the ability to distinguish lymph node metastasis, which was confirmed in the validation group (area under the ROC curve was 0.847). The nomogram and clinical decision curve also performed well in the follow-up analysis, which proved its potential clinical value. ConclusionThis study provides a nomogram combined with clinicopathological characteristics, which can be used to predict the risk of lymph node metastasis in patients with lung adenocarcinoma with a diameter≤3 cm.
ObjectiveTo analyze the predictive factors for central lymph node metastasis in papillary thyroid microcarcinoma (PTMC), and explore the treatment method for the patients with PTMC. MethodThe literatures were reviewed according to the results searched from PubMed in recent years. ResultsCentral lymph node metastases were common in the patients with PTMC. It was important for prophylactic central lymph node dissection so it might reduce the local recurrence and comfirm the clinical staging, further more provide the strategies for the postoperative therapy. ConclusionsLymphadenectomy is necessary for patients with lymph node metastasis. Prophylactic central lymph node dissection should be performed for patients without lymph node metastasis but with one risk factor or more.
ObjectiveTo investigate the effects of thyroid globulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) statuses on central lymph node (CLN) metastasis in patients with differentiated thyroid cancer (DTC).MethodsA retrospective analysis was performed on 526 patients with DTC confirmed by pathology from nine participating institutions, who underwent the bilateral thyroidectomy plus bilateral CLN dissection. The clinicopathologic characteristics of different TGAb and TPOAb statuses of patients with DTC were compared, and whether the TGAb and TPOAb statuses were the independent risk factors of CLN metastasis in DTC patients or not was analyzed.ResultsAll of 526 patients with DTC were included in this study, 152 were males and 374 were females. The age was (44±11) years old. There were 63 cases of TgAb＋TPOAb＋, 60 cases of TgAb＋TPOAb－, 30 cases of TgAb－TPOAb＋, and 373 cases of TgAb－TPOAb－. It was found that there was a significant difference in the gender among the four different antibody statuses of patients, that was, women with abnormal antibodies were more common (P<0.001), not found that there were related to the tumor size, blood vessel invasion, nerve invasion, CLN metastasis, tumor multifocality, and bilateral tumor or not (P>0.050). In this study, there were 389 cases of CLN with metastasis and 137 cases of CLN without metastasis. The results of multivariate analysis found that the age and gender of the patients were the independent risk factors (P<0.001), but didn’t find the TgAb and TPOAb Statuses and other factors were related to the CLN metastasis (P>0.050).ConclusionsStatuses of TGAb and TPOAb aren’t obviously associated with CLN metastasis in patients with DTC, which is inconsistent with other studies. It needs to be further researched after expanding existing sample size and determining new predictive factors.
ObjectiveTo summarize the research progress of ultrasmall superparamagnetic iron oxide (USPIO) enhanced magnetic resonance imaging (MRI) in normal-sized lymph node metastasis of colorectal cancer.MethodThe relevant literatures published recently at domestic and abroad about USPIO enhanced MRI in normal-sized lymph node metastasis of colorectal cancer were collected and reviewed.ResultsUSPIO, a kind of lymph node targeted magnetic resonance contrast agent, could be used to evaluate lymph node metastasis of malignant tumors. USPIO enhanced MRI could detect normal-sized lymph node metastasis in colorectal cancer effectively compared with normal MRI. It provided a higher diagnostic performance than normal enhanced MRI. In addition, USPIO enhanced MRI could also distinguish inflammatory and metastatic lymph nodes better that were difficult to be distinguished by normal enhanced MRI.ConclusionUSPIO enhanced MRI shows a certain potential for clinical application in detecting normal-sized lymph node metastasis of colorectal cancer, but it has not been widely used in China.
Objective To summarize the influencing factors of central lymph node metastasis in thyroid papillary carcinoma. Method Relevant literature about papillary thyroid carcinoma were reviewed and predictive factors of central lymph node metastasis were summarized. Results Studies had shown that, male, younger age, larger tumor size, multifocal, and BRAF mutations were risk factors for central lymph node metastasis in thyroid papillary carcinoma, while tumors located in the upper pole and combined with Hashimoto disease (HT) were the protective factors for central lymph node metastasis. Conclusions The central lymph node metastasis detection rate is low, so it is unable to meet with the preoperative diagnosis in papillary thyroid carcinoma. A large number of studies have confirmed that clinical pathological features have predictive value for preoperative lymph node diagnosis, and can provide a reference for the selection of surgical methods in thyroid papillary carcinoma.
Abstract： Objective To analyze the modes and rules of subcarinal lymph node metastasis in non-small cell lung cancer patients， and explore appropriate surgical dissection strategy of subcarinal lymph nodes for patients with non-small cell lung cancer. Methods The clinical data of 608 patients with non-small cell lung cancer who underwent lung resection and systematic lymph node dissection in Henan Cancer Hospital from September 2002 to October 2011 were analyzed retrospectively. There were 388 males and 220 females with an average age of 62.3 （45-78） years. There were 122 patients with left upper lobe tumor， 119 patients with left lower lobe tumor， 158 patients with right upper lobe tumor， 40 patients with right middle lobe tumor and 169 patients with right lower lobe tumor. Subcarinal lymph node metastasis was observed in 118 patients （19.4%）. There were 244 patients with squamous carcinoma， 285 patients with adenocarcinoma and 79 patients with other types of carcinoma. The relationship of subcarinal lymph node metastasis with tumor location， pathological types and clinicopathological characteristics were analyzed. Results There was statistical difference in subcarinal lymph node metastasis rate among different tumor locations （P=0.000）. Subcarinal lymph node metastasis rate was the highest ［45.8% （54/118）］ in patients with right lower lobe tumor. For patients with different pathological types， subcarinal lymph node metastasis rate was the highest ［55.9% （66/118）］ in patients with adenocarcinoma， and then squamous carcinoma （P=0.034）. Subcarinal lymph node metastasis rate increased with the increase in T staging， and patients with tumors located in the middle or lower lobe of the left or right lung had a significantly higher subcarinal lymph node metastasis rate than patients with upper lobe tumor. Conclusion Subcarinal lymph node metastasis rate are lower in patients with left or right upper lobe tumor， patients with squamous carcinoma whose clinical T staging is within cT 1 .