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.
Objective To investigate the efficacy of fine needle aspiration-thyroglobulin (FNA-Tg) with colloidal gold immunochromatographic assay (CGICA) on the assessment of lymph node metastasis during surgery in papillary thyroid carcinoma (PTC) patients. Methods Seventy-eight patients with PTC who underwent surgery in the Department of Thyroid Surgery of West China Hospital of Sichuan University from August to December 2019 were selected as the research objects, 289 neck lymph node specimens cleaned during the operation were prepared into eluent after lymph node FNA within 10 minutes in vitro, and then the FNA-Tg level was detected rapidly and quantitatively by CGICA. The specimen of washout fluid was labeled and sent to the laboratory for FNA-Tg detection by Roche electrochemiluminescence immunoassay. The lymph nodes in the whole group were divided into central region group and lateral cervical region group according to their location. According to the long diameter of lymph nodes, they were divided into <5 mm group, 5–10 mm group and >10 mm group. With postoperative pathological report as the gold standard, the receiver operating characteristic (ROC) curve of the whole group of data subjects was drawn, and the area under curve (AUC) was compared to calculate the best cut-off value of FNA-Tg in diagnosing PTC lymph node metastasis. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of FNA-Tg CGICA method and Roche method in the whole group and different subgroups were compared. The data of 55 lymph nodes detected by FNA-Tg CGICA method and rapid frozen pathology were collected, and the diagnostic efficacy indexes of CGICA method and rapid frozen pathology in the diagnosis of lymph node metastasis were compared. Results The ROC curves AUC of FNA-Tg detected by CGICA method and Roche method was 0.850 and 0.883, respectively, the difference was not statistically significant (Z=1.011, P>0.05). The sensitivity was 77.7% and 79.6% respectively (χ2=0.05, P>0.05), specificity was 84.9% and 93.5% respectively (χ2=7.50, P<0.05). Using McNemar test, there was no significant difference in the diagnostic results between the CGICA method and Roche method of FNA-Tg in the whole group (P>0.05). The diagnostic efficacy of FNA-Tg CGICA method was better in the lateral cervical region group than that in the central region group, and the diagnostic efficacy of the group with the long diameter of lymph nodes >10 mm was better than those of the groups with the long diameter of lymph nodes <5 mm and 5–10 mm. There was no significant difference in diagnostic results between FNA-Tg CGICA method and rapid frozen pathology (P>0.05). Conclusions The FNA-Tg CGICA method has high value in diagnosing PTC cervical lymph node metastasis, and has the characteristics of rapidity and convenience. The diagnostic efficiency is similar to that of Roche method.
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 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.
Objective To explore the influencing factors of lymph node metastasis of Siewert Ⅱ/Ⅲ gastroesophageal junction adenocarcinoma (AEG) and its influence on prognosis of this kind of patients. Methods The clinical and pathological data of 49 patients with Siewert Ⅱ/Ⅲ AEG who admitted to Shiyan Hospital of Traditional Chinese from January 2010 to January 2013 were retrospectively analyzed. Univariate and multivariate analyses of factors affecting lymph node metastasis of AEG were performed by using a chi-square test and an unconditional logistic regression model; the effect of lymph node metastasis on the prognosis of patients with Siewert Ⅱ/Ⅲ AEG was performed by log-rank test. Results Multivariate unconditional logistic regression analysis showed that, tumor diameter (P=0.008), depth of invasion (P=0.019), vascular tumor thrombus (P=0.020), and degree of differentiation (P=0.017) were all influencing factors of lymph node metastasis. Patients with Siewert Ⅱ/Ⅲ AGE without lymph node metastasis had better survival than those with lymph node metastasis (P=0.005). Conclusion Tumor diameter, depth of invasion, degree of differentiation, and vascular tumor thrombus are independent risk factors for lymph node metastasis in patients with Siewert Ⅱ/Ⅲ AEG, and lymph node metastasis is associated with poor prognosis.
Objective To investigate the primary peripheral non-small cell lung cancer (NSCLC) in stage T1 of TNM (UICC2011) (the tumor size≤3 cm) and to find out the lymphadenectomy way which will benefit patients most. Methods We retrospectively analyzed the clinical data of 60 patients with primary peripheral NSCLC in our hospital between November 2014 and May 2015. There were 26 males and 34 females at age of 34-76 (57.91±7.75) years. The lymph nodes dissection and metastasis were recorded. Results The total number of intrathoracic lymph nodes dissection is 1 208,with an average of 20.1, including 33 metastasis lymph nodes. The metastasis rate was 2.73%. A total of 51 patients were not found the mediastinum and hilum metastasis lymph node through the routine pathological detection method，while metastasis lymph node in section 12 and (or) 13 and (or) 14 group were found in 3 patients in our trial. The detection rate was 5.89%. For stage T1 primary peripheral NSCLC, with increasing tumor size, lymph node metastasis rate was gradually increased. The patients with solid lesions were more likely to have lymph node metastasis than those with non-solid lesions (pure ground-glass nodules or mixed ground-glass nodules) which generally did not find lymph node metastasis. Conclusion The lymph node metastasis rate in stage T1 primary peripheral NSCLC is related to the tumor size, nature, histological type, local pleural stretch in imaging. The dissection of lung lymph node (12+13+14 groups)may be able to find simple intrapulmonary lymph nodes metastasis. It is important to the selection of delineated staging and treatment program in stage T1 primary peripheral NSCLC.
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.
Lymph node metastasis is the main and frequent metastatic way of lung cancer, it is also the reason of postoperative carcinoma residue which results in relapse and metastasis. It is vital to clean mediastinal lymph nodes and hilar lymph nodes in lung cancer operation. However, the patterns of lymphadenectomy are not yet uniform. There are complete mediastinal lymph node dissection(CMLND), radical lymph node dissection(RLND), lymph node sampling(LS), systematic lymph node sampling(SS) and sentinel lymph node navigation(SLN). And with the development of minimal invasive surgery, the thoracoscopic lymphadenectomy gets mature day by day. It is very necessary to find a more standardized and perfect patten of lymphadenectomy. This paper reviews the clinical significance, the pattens and the extent of mediastinal lymph node dissection and hilar lymph node dissection, and also reviews the current status and prospect of thoracoscopic lymphadenectomy
Objective To investigate the expression of claudin-1 in breast tumor tissues and the relationship of development and progress of breast neoplasm．Methods The expressions of claudin-1 in 89 cases of breast cancer and 37 benign breast diseases were tested by tissue chip technology and immunohistochemistry．The relationships of claudin-1 expression to the lymph node metastasis，TNM staging，maximum diameter of the tumor，and histology grade were statistically analyzed．Results The expression of claudin-1 in the breast cancer was significantly lower than that in the benign breast disease（χ2=19.20，P=0.000 2）．The claudin-1 expression in the patients with lymph node metastasis was significantly lower than that without lymph node metastasis （χ2=3.85，P=0.049 7）．The claudin-1 expression in the stageⅢ of TNM staging was weaker than that in the stage Ⅰ（χ2=5.29，P=0.021 4） and stage Ⅱ （χ2=7.46，P=0.006 3），respectively. There was no significant difference of the claudin-1 expression in the different maximum diameters of tumor （χ2=1.58，P=0.453 8） or histology grades （χ2=1.02，P=0.600 5），respectively．Conclusions The expression of claudin-1 might be correlated with the occurrence，development，and metastasis in breast tumor．It may be one of the potential indicator for lymph node metastasis and prognosis assessment in breast cancer．
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.