Objective To study the necessity and feasibility of No.12b lymph node dissection in D2 lymphadenectomy for advanced distal gastric cancer, and the relation between No.12b lymph node metastasis and clinicopathologic factors. Methods Clinical data of sixty cases of advanced distal gastric cancer receiving D2 or D2+ radical correction were collected retrospectively, both of which were all plus No.12b lymph node dissections. The relationships between No.12b lymph node metastasis and clinicopathologic factors were analyzed. Results No death attributed to operation or severe operative complications were found. There were 12 cases (20.00%) with No.12b lymph node metastasis. The rates of No.12b lymph node metastasis in Borrmann Ⅲ-Ⅳ types, N2-3 of lymph node metastasis and T3-4 of tumor infiltration were 31.25% (10/32), 30.30% (10/33) and 29.73% (11/37), which were significantly higher than those in Borrmann Ⅰ-Ⅱ types 〔7.14% （2/28）〕, N0-1 〔7.41% （2/27）〕 and T1-2 〔4.35% （1/23）〕 respectively (Plt;0.05). There was no relationship between tumor size and No.12b lymph node metastasis. Conclusions No.12b lymph node dissection is safe and feasible for advanced distal gastric cancer. Further perspective studies on No.12b lymph node dissection influence on prognosis in more cases are required.
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 explore the causes and surgical strategies of completion thyroidectomy for thyroid cancer. Method The clinical data of 35 patients with thyroid cancer who underwent completion thyroidectomy in Guizhou Provincial People’s Hospital from January 2020 to July 2022 were analyzed retrospectively. Results There were 23 females and 12 males, aged from 17 to 68 years (median 42 years). The nature of thyroid nodules in 22 patients was not determined at preoperative fine needle aspiration cytology or intraoperative frozen pathological examination, but the paraffin section examination after operation indicated thyroid cancer. Pathological examination after the first operation showed that 11 patients had a large number of lymph node metastasis in the central area (more than 5), and 2 patients were confirmed as medullary thyroid carcinoma. All the 35 patients underwent completion thyroidectomy at 5–93 days after the initial operation, among which 3 patients underwent resection of the affected side residual glandular lobe and isthmus ± ipsilateral CLN dissection, 18 patients underwent contralateral lobectomy and CLN cleaning, and 14 patients underwent contralateral lobectomy and lymph node dissection of the affected side cervical region (Ⅲ–Ⅳ region). The operative time was 45–135 min (median 105 min). Intraoperative blood loss was 10–50 mL (median 20 mL). One patient suffered from temporary recurrent laryngeal nerve injury after operation, and voice had returned to normal at 5 months after operation. Six patients showed temporary hypoparathyroidism, and serum parathyroid hormone returned to normal level in 1–3 months after symptomatic treatment. Nineteen patients were treated with iodine-131 after operation, and were followed-up for 1–16 months (median 12 months). No signs of tumor recurrence or metastasis were found. Conclusions Accurate preoperative and intraoperative evaluation of thyroid nodules and standardized surgery can reduce the incidence of completion thyroidectomy. For patients who really need completion thyroidectomy, adequate doctor-patient communication during the perioperative period, early response measures and appropriate completion thyroidectomy can reduce the probability of postoperative tumor recurrence and improve the survival of patients.
ObjectiveTo analyze the relevant factors of levelⅡlymph node metastasis in papillary thyroid carci-noma. MethodsThe clinicopathologic data of 83 patients from November 2011 to March 2014 were analyzed retrospec-tively. All the primary tumors were papillary thyroid carcinoma located in unilateral lobe with ipsilateral lateral neck lymph node metastasis. The relationship of gender, age, microcarcinoma, superior pole involved by carcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis was analyzed. The calculated data were analyzed with Chi-Square test and there was significant difference when P < 0.05. ResultsThe rate of lymph node metastasis at levelⅡ, Ⅲ, Ⅳ, Ⅴ, Ⅵwas 51.8% (43/83), 78.3% (65/83), 71.7% (59/83), 4.8% (4/56), and 79.5% (66/83), respectively. There was no significant relationship of gender, age, microcarcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis (P > 0.05). The rate of lymph node metastasis at levelⅡwas significantly higher when superior pole involved by carcinoma (P < 0.05). ConclusionAmong the patients with papillary thyroid carcinoma, when superior pole involved by carcinoma the patient should be underwent selective neck dissection, the proper extent of dissection including levelⅡshould be performed.
Systematic lymph nodes dissection has been a standard procedure in lung cancer surgery, while the manipulation of mediastinal lymph nodes for early stage lung cancer remains controversial since surgeons have been weighing the advantages and disadvantages of different methods of lymph node dissection. With an increasing in early stage non-small cell lung cancer patients in recent years, there are more and more intensive studies especially focusing on the mediastinal lymph nodes dissection of clinical stage ⅠA lung cancer. In this review, the lymph nodes management of clinical stage ⅠA non-small cell lung cancer, especially systematic lymph nodes dissection and sampling as well as lobe-specific lymph node dissection, are summarized.
ObjectiveTo investigate the influencing factors of cervical lymph node metastasis of papillary thyroid carcinoma (PTC) and provide more accurate guidance for the cleaning strategy of PTC cervical lymph node.MethodsRetrospectively analyzed the case data of pathological diagnosis of PTC patients from June 2013 to June 2019 in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, and explored the influencing factors of lymph node metastasis in central region and lymph node metastasis in lateral cervical region.ResultsThe results of multivariate analysis showed that patients aged ≤55 years old, tumor diameter >1 cm, peripheral invasion, bilateral cancer, and multifocal cancer had a higher lymph node metastasis rate in the central region (P<0.05). When the number of risk factors mentioned above was 0, 1, 2, 3, 4, 5 and 6, the lymph node metastasis rate in the central region was respectively: 3.5% (4/113), 25.2% (72/286), 30.0% (70/233), 38.6% (76/197), 52.5% (53/101), 76.9% (20/26), and 100% (13/13). With the increase of the number of risk factors, the lymph node metastasis rate in central region increased (χ2=236.894, P<0.001). In the lymph node metastasis in lateral cervical region, multivariate analysis showed that patients with tumor diameter >1 cm, membranous invasion, and lymph node metastasis in the central region ≥2 had a higher lymph node metastasis rate (P<0.05), while lymph node metastasis in the lateral cervical region was not related to age, gender, peripheral invasion, and multifocal carcinoma (P>0.05). When the cumulative number of risk factors in patients was 0, 1, 2, 3, 4, 5, and 6, the lymph node metastasis rate in the lateral cervical region was respectively: 11.1% (1/9), 29.4% (5/17), 79.2% (19/24), 89.6% (43/48), 96.4% (27/28), 100% (21/21), and 100% (3/3). With the increase in the number of risk factors, lymph node metastasis in the lateral cervical region increased (χ2=101.094, P<0.001).ConclusionsThe cervical lymph node metastasis is positively correlated with the number of corresponding risk factors. With the increase of risk factors, cervical lymph node metastasis rate also increases. The number of risk factors provides a simple and intuitive indicator for cervical lymph node metastasis, which is more conducive to the formulation of individualized and accurate surgical program.
Objective To investigate the effect of radiotherapy after neoadjuvant chemotherapy and modified radical surgery on breast cancer specific survival (BCSS) of patients with stage cT1–2N1M0 breast cancer. Methods A total of 917 cT1–2N1M0 stage breast cancer patients treated with neoadjuvant chemotherapy and modified radical surgery from 2010 to 2017 were extracted from the The Surveillance, Epidemiology, and End Results (SEER) database. Of them 720 matched patients were divided into radiotherapy group (n=360) and non-radiotherapy group (n=360) by using propensity score matching (PSM). Cox proportional hazard regression model was used to explore the factors affecting BCSS. Results Patients were all interviewed for a median follow-up of 65 months, and the 5-year BCSS was 91.9% in the radiotherapy group and 93.2% in the non-radiotherapy group, there was no significant difference between the 2 groups (χ2=0.292, P=0.589). The results were the same in patients with no axillary lymph node metastasis, one axillary lymphnode metastasis, two axillary lymph node metastasis and 3 axillary lymph node metastasis group (χ2=0.139, P=0.709; χ2=0.578, P=0.447; χ2=2.617, P=0.106; χ2=0.062, P=0.803). The result of Cox proportional hazard regression analysis showed that, after controlling for Grade grade, time from diagnosis to treatment, efficacy of neoadjuvant chemotherapy, number of positive axillary lymph nodes, molecular typing, and tumor diameter at first diagnosis, radiotherapy had no statistically significant effect on BCSS [HR=1.048, 95%CI (0.704, 1.561), P=0.817]. Conclusions The effect of radiotherapy on the BCSS of patients with stage cT1–2N1M0 breast cancer who have received neoadjuvant chemotherapy and modified radical surgery with 0 to 3 axillary lymph nodes metastases is limited, but whether to undergo radiotherapy should still be determined according to the comprehensive risk of individual tumor patients.
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.
ObjectiveTo investigate the correlation between expression of stromal interaction molecule 1 (STIM1) and tumor malignant degree or lymph node metastasis in patients with gastric cancer. MethodsA total of 83 patients with gastric cancer treated in the Affiliated Hospital of Southwest Medical University and Sichuan Mianyang 404 Hospital from October 2018 to April 2021 were collected. The expression of STIM1 protein in the gastric cancer tissues and the corresponding adjacent normal gastric tissues was detected by immunohistochemistry method. Meanwhile the correlation between the expression of STIM1 protein and clinicopathologic features or postoperative lymph node status of the patients with gastric cancer was analyzed. ResultsThe positive rate of STIM1 protein expression in the gastric cancer tissues was 95.2% (79/83), including 62 (74.7%) patients with high expression (STIM1 scoring 5–7) and 21 (25.3%) patients with low expression (STIM1 scoring 2–4), which in the corresponding adjacent normal gastric tissues was 41.0% (34/83), the difference was statistically significant (χ2=58.078, P<0.001). The expression of STIM1 protein was not related to gender, age, and tumor size of the patients with gastric cancer (P>0.05), while the proportions of the patients with high expression of STIM1 protein in the gastric cancer patients with low/undifferentiated tumor, T3+T4 of infiltration depth, TNM stage Ⅲ, and lymph node metastasis were higher than those with high/medium differentiation (χ2=11.052, P=0.001), T1+T2 of infiltration depth (χ2=24.720, P<0.001), TNM stage Ⅰ+Ⅱ (χ2=9.980, P=0.002), and non-lymph node metastasis (χ2=6.097, P=0.014). The expression intensity of STIM1 protein was positively correlated with the number of lymph node metastasis (r=0.552, Z=–3.098, P=0.002) and the rate of lymph node metastasis (r=0.561, Z=–6.387, P<0.001). ConclusionsPositive rate of STIM1 protein expression in gastric cancer tissues is relatively high. STIM1 protein expression in gastric cancer tissue is closely related to tumor malignancy and lymph node metastasis, so it might play an important role in progression of gastric cancer.
ObjectiveTo investigate the risk factors for lymph node metastasis in resectable lung adenocarcinoma by combining spatial location, clinical, and imaging features, and to construct a lymph node metastasis prediction model. MethodsA retrospective study on patients who underwent chest computed tomography (CT) at the First Affiliated Hospital of Nanjing Medical University from June 2016 to June 2020 and were surgically confirmed to have invasive lung adenocarcinoma with or without lymph node metastasis was conducted. Patients were divided into a positive group and a negative group based on the presence or absence of lymph node metastasis. Clinical and imaging data of the patients were collected, and the independent risk factors for lymph node metastasis in resectable lung adenocarcinoma were analyzed using univariate and multivariate logistic regression. A combined spatial location-clinical-imaging feature prediction model for lymph node metastasis was established and compared with the traditional lymph node metastasis prediction model that does not include spatial location features. ResultsA total of 611 patients were included, with 333 in the positive group, including 172 males and 161 females, with an average age of (58.9±9.7) years; and 278 in the negative group, including 127 males and 151 females, with an average age of (60.1±11.4) years. Univariate and multivariate logistic regression analyses showed that the spatial relationship of the lesion to the lung hilum, nodule type, pleural changes, and serum carcinoembryonic antigen (CEA) levels were independent risk factors for lymph node metastasis. Based on this, the combined spatial location-clinical-imaging feature prediction model had a sensitivity of 91.67%, specificity of 74.05%, accuracy of 87.88%, and area under the curve (AUC) of 0.885. The traditional lymph node metastasis prediction model, which did not include spatial location features, had a sensitivity of 76.40%, specificity of 72.10%, accuracy of 53.86%, and AUC of 0.827. The difference in AUC between the two prediction methods was statistically significant (P=0.026). Compared with the traditional prediction model, the predictive performance of the combined spatial location-clinical-imaging feature prediction model was significantly improved. ConclusionIn patients with resectable lung adenocarcinoma, those with basal spatial location, solid density, pleural changes with wide base depression, and elevated serum CEA levels have a higher risk of lymph node metastasis.