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@#Objective To investigate the radiomics features to distinguish invasive lung adenocarcinoma with micropapillary or solid structure. Methods A retrospective analysis was conducted on patients who received surgeries and pathologically confirmed invasive lung adenocarcinoma in our hospital from April 2016 to August 2019. The dataset was randomly divided into a training set [including a micropapillary/solid structure positive group (positive group) and a micropapillary/solid structure negative group (negative group)] and a testing set (including a positive group and a negative group) with a ratio of 7∶3. Two radiologists drew regions of interest on preoperative high-resolution CT images to extract radiomics features. Before analysis, the intraclass correlation coefficient was used to determine the stable features, and the training set data were balanced using synthetic minority oversampling technique. After mean normalization processing, further radiomics features selection was conducted using the least absolute shrinkage and selection operator algorithm, and a 5-fold cross validation was performed. Receiver operating characteristic (ROC) curves were depicted on the training and testing sets to evaluate the diagnostic performance of the radiomics model. Results A total of 340 patients were enrolled, including 178 males and 162 females with an average age of 60.31±6.69 years. There were 238 patients in the training set, including 120 patients in the positive group and 118 patients in the negative group. There were 102 patients in the testing set, including 52 patients in the positive group and 50 patients in the negative group. The radiomics model contained 107 features, with the final 2 features selected for the radiomics model, that is, Original_ glszm_ SizeZoneNonUniformityNormalized and Original_ shape_ SurfaceVolumeRatio. The areas under the ROC curve of the training and the testing sets of the radiomics model were 0.863 (95%CI 0.815-0.912) and 0.857 (95%CI 0.783-0.932), respectively. The sensitivity was 91.7% and 73.7%, the specificity was 78.8% and 84.0%, and the accuracy was 85.3% and 78.4%, respectively. Conclusion There are differences in radiomics features between invasive pulmonary adenocarcinoma with or without micropapillary and solid structures, and the radiomics model is demonstrated to be with good diagnostic value.
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BACKGROUND@#In China, lung cancer remains the cancer with the highest incidence and mortality rate. Among early-stage lung adenocarcinomas (LUAD), the micropapillary (MPP) component is prevalent and typically exhibits high aggressiveness, significantly correlating with early metastasis, lymphatic infiltration, and reduced five-year survival rates. Therefore, the study is to explore the similarities and differences between MPP and non-micropapillary (non-MPP) components in malignant pulmonary nodules characterized by GGOs in early-stage LUAD, identify unique mutational features of the MPP component and analyze the relationship between the ZNF469 gene, a member of the zinc-finger protein family, and the prognosis of early-stage LUAD, as well as its correlation with immune infiltration.@*METHODS@#A total of 31 malignant pulmonary nodules of LUAD were collected and dissected into paired MPP and non-MPP components using microdissection. Whole-exome sequencing (WES) was performed on the components of early-stage malignant pulmonary nodules. Mutational signatures analysis was conducted using R packages such as maftools, Nonnegative Matrix Factorization (NMF), and Sigminer to unveil the genomic mutational characteristics unique to MPP components in invasive LUAD compared to other tumor tissues. Furthermore, we explored the expression of the ZNF469 gene in LUAD using The Cancer Genome Atlas (TCGA) database to investigate its potential association with the prognosis. We also investigated gene interaction networks and signaling pathways related to ZNF469 in LUAD using the GeneMANIA database and conducted Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Lastly, we analyzed the correlation between ZNF469 gene expression and levels of immune cell infiltration in LUAD using the TIMER and TISIDB databases.@*RESULTS@#MPP components exhibited a higher number of genomic variations, particularly the 13th COSMIC (Catalogue of Somatic Mutations in Cancer) mutational signature characterized by the activity of the cytidine deaminase APOBEC family, which was unique to MPP components compared to non-MPP components in tumor tissues. This suggests the potential involvement of APOBEC in the progression of MPP components in early-stage LUAD. Additionally, MPP samples with high similarity to APOBEC signature displayed a higher tumor mutational burden (TMB), indicating that these patients may be more likely to benefit from immunotherapy. The expression of ZNF469 was significantly upregulated in LUAD compared to normal tissue, and was associated with poor prognosis in LUAD patients (P<0.05). Gene interaction network analysis and GO/KEGG enrichment analysis revealed that COL6A1, COL1A1, COL1A2, TGFB2, MMP2, COL8A2 and C2CD4C interacted with ZNF469 and were mainly involved in encoding collagen proteins and participating in the constitution of extracellular matrix. ZNF469 expression was positively correlated with immune cell infiltration in LUAD (P<0.05).@*CONCLUSIONS@#The study has unveiled distinctive mutational signatures in the MPP components of early-stage invasive LUAD in the Asian population. Furthermore, we have identified that the elevated expression of mutated ZNF469 impacts the prognosis and immune infiltration in LUAD, suggesting its potential as a diagnostic and prognostic biomarker in LUAD.
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Humans , Lung Neoplasms/genetics , Adenocarcinoma of Lung/genetics , China , Prognosis , Transcription FactorsABSTRACT
@#Lung adenocarcinoma has become the most common type of lung cancer. According to the 2015 World Health Organization histological classification of lung cancer, invasive lung adenocarcinoma can be divided into 5 subtypes: lepidic, acinar, papillary, solid, and micropapillary. Relevant studies have shown that the local lobectomy or sublobectomy is sufficient for early lepidic predominant adenocarcinoma, while lobectomy should be recommended for tumors containing micropapillary and solid ingredients (≥5%). Currently, the percentage of micropapillary and solid components diagnosed by frozen pathological examination is 65.7%, and the accuracy of diagnosis is limited. Therefore, to improve the accuracy of diagnosis, it is necessary to seek new methods and techniques. This paper summarized the characteristics and rapid diagnosis tools of early lung adenocarcinoma subtypes.
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El microcarcinoma papilar de tiroides es definido como un tumor de un cm o menos de diámetro mayor. La mayoría permanecen ocultos clínicamente, siendo un hallazgo en autopsias hasta en 36%. La presentación oculta ocurre hasta en un 10 a 26% de todas las neoplasias malignas de tiroides y se define como la presencia de ganglios metastásicos de carcinoma papilar de tiroides en ausencia de lesión primitiva tiroidea evidente durante la exploración clínica y ecográfica. El objetivo de este trabajo es el reporte de dos casos donde el diagnóstico de cáncer de tiroides se realizó a través de su presentación metastásica cervical, siendo el estudio anatomopatológico de la pieza de resección quirúrgica el que devela la presencia de un microcarcinoma papilar. Si bien el tratamiento del de estas lesiones es controversial, existen elementos que sellan la necesidad de resolución quirúrgica. En el debut metastásico ganglionar cervical, está indicada la tiroidectomía total con el vaciamiento ganglionar cervical radical modificado ipsilateral y central. El raidioyodo postquirúrgico será empleado en forma complementaria ante la persistencia, recurrencia o elementos de alto riesgo.
Papillary thyroid microcarcinoma is defined as a tumor one cm or less in diameter. Most remain clinically hidden, being an autopsy finding in up to 36%. Occult presentation occurs in up to 10% to 26% of all thyroid malignancies and is defined as the presence of metastatic nodes from papillary thyroid carcinoma in the absence of a primitive thyroid lesion evident on clinical and ultrasound examination. The objective of this work is the report of two cases where the diagnosis of thyroid cancer was made through its cervical metastatic presentation, being the pathological study of the surgical resection specimen that reveals the presence of a papillary microcarcinoma. Although the treatment of these lesions is controversial, there are elements that seal the need for surgical resolution. In cervical lymph node metastatic debut, total thyroidectomy with modified ipsilateral and central radical cervical lymph node dissection is indicated. Post-surgical radiation iodine will be used in a complementary way in the event of persistence, recurrence or high-risk elements.
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Humans , Male , Female , Adult , Thyroid Neoplasms/pathology , Thyroid Cancer, Papillary/pathology , Thyroidectomy , Thyroid Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Thyroid Cancer, Papillary/surgery , Thyroid Cancer, Papillary/diagnosis , Lymph Nodes , Lymphatic MetastasisABSTRACT
Objective: Solid and micropapillary pattern are highly invasive histologic subtypes in lung adenocarcinoma and are associated with poor prognosis while the biopsy sample is not enough for the accurate histological diagnosis. This study aims to assess the correlation and predictive efficacy between metabolic parameters in (18)F-fluorodeoxy glucose positron emission tomography/computed tomography ((18)F-FDG PET-CT), including the maximum SUV (SUV(max)), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and solid and micropapillary histological subtypes in lung adenocarcinoma. Methods: A total of 145 resected lung adenocarcinomas were included. The clinical data and preoperative (18)F-FDG PET-CT data were retrospectively analyzed. Mann-Whitney U test was used for the comparison of the metabolic parameters between solid and micropapillary subtype group and other subtypes group. Receiver operating characteristic (ROC) curve and areas under curve (AUC) were used for evaluating the prediction efficacy of metabolic parameters for solid or micropapillary patterns. Univariate and multivariate analyses were conducted to determine the prediction factors of the presence of solid or micropapillary subtypes. Results: Median SUV(max) and TLG in solid and papillary predominant subtypes group (15.07 and 34.98, respectively) were significantly higher than those in other subtypes predominant group (6.03 and 10.16, respectively, P<0.05). ROC curve revealed that SUV(max) and TLG had good efficacy for prediction of solid and micropapillary predominant subtypes [AUC=0.811(95% CI: 0.715~0.907) and 0.725(95% CI: 0.610~0.840), P<0.05]. Median SUV(max) and TLG in lung adenocarcinoma with the solid or micropapillary patterns (11.58 and 22.81, respectively) were significantly higher than those in tumors without solid and micropapillary patterns (4.27 and 6.33, respectively, P<0.05). ROC curve revealed that SUV(max) and TLG had good efficacy for predicting the presence of solid or micropapillary patterns [AUC=0.757(95% CI: 0.679~0.834) and 0.681(95% CI: 0.595~0.768), P<0.005]. Multivariate logistic analysis showed that the clinical stage (Stage Ⅲ-Ⅳ), SUV(max) ≥10.27 and TLG≥7.12 were the independent predictive factors of the presence of solid or micropapillary patterns (P<0.05). Conclusions: Preoperative SUV(max) and TLG of lung adenocarcinoma have good prediction efficacy for the presence of solid or micropapillary patterns, especially for the solid and micropapillary predominant subtypes and are independent factors of the presence of solid or micropapillary patterns.
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Humans , Adenocarcinoma of Lung/diagnostic imaging , Fluorodeoxyglucose F18/metabolism , Lung Neoplasms/pathology , Multimodal Imaging/methods , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography/methods , Prognosis , Radiopharmaceuticals , Retrospective Studies , Tomography, X-Ray Computed/methods , Tumor BurdenABSTRACT
@#Objective To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.
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Objective@#To analyze the role of thyroid imaging reporting and data system(TI-RADS), contrast-enhanced ultrasound(CEUS), fine needle aspiration cytology (FNAC) and tumor proliferation related genes in the early diagnosis of thyroid micro-papillary carcinoma(PTMC) and risk assessment of early metastasis.@*Methods@#From May 2018 to May 2019, a total of 140 patients with Thyroid micronodules for surgical resection and pathological diagnosis of benign or malignant into the Seventh People′s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine for the retrospective study.There were 90 cases in benign group and 50 cases in malignant group.The levels of TI-RADS, CEUS enhancement mode, peak intensity (PI) and cyclin D1 (CCND1), cell nuclear Proliferating Antigen (PCNA) and vascular endothelial growth factor (VEGF) were compared between malignant and benign groups, VEGF) mRNA expression level.The positive rate of FNAC, TNM stage, capsule invasion and lymph node metastasis were evaluated.@*Results@#The percentage of class four and more by TI-RADS grade in malignant group was significantly more than benign group((92.0% (46/50) vs.5.6% (5/90), χ2=103.718, P<0.001), more early low enhancement by CEUS(86.0%(43/50) VS.6.7%(6/90), χ2=91.328, P<0.001) and PI value higher than benign group, too((6.79±1.88) VS.(5.32±1.46), t=4.968, P=0.008). The positive rate of FNAC in malignant group was 92.0% (46/50). FNAC was positive in 42 cases of TNM stage, 9 cases of capsule invasion and 6 cases of lymph node metastasis.The pathological positive rate after resection was 50 cases of TNM stage, 10 cases of capsule invasion and 6 cases of lymph node metastasis.The expression of CCND1, PCNA and VEGF mRNA in malignant group was significantly higher than that in benign group((0.5624±0.134) VS.(0.213±0.097), t=15.639, P<0.001; (0.453±0.126) VS.(0.186±0.056), t=20.253, P<0.001; (0.633±0.159) VS.(0.252±0.097), t=31.265, P<0.001).@*Conclusion@#Ultrasound-guided FNAC is used to determine TNM staging, capsule invasion and lymph node metastasis, CCND1, PCNA and VEGF expression level, contrast-enhanced mode and peak intensity value measured by quantitative evaluation software have good accuracy for early diagnosis of PTMC, and are consistent with the pathological results of hand surgery.
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Lung micropapillary adenocarcinoma is characterized by frequent metastasis, lymph node infiltration, high recurrence rate and low overall survival rate as a high-grade lung adenocarcinoma. Special oncogenic pathway is activated and immune microenvironment is established in this subtype of tumor. This article reviews the Pathological phenomena and molecular features of micropapillary adenocarcinoma studied in recent years, aiming to deepen the understanding of micropapillary lesions and lay the foundation for formulating specific treatment strategies. .
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Objective: To investigate the clinicopathological risk factors of spread through air space (STAS) in stage A lung adenocarcinoma. Methods: The clinical data of patients with stage A lung adenocarcinoma who underwent lung surgery in Shanghai Chest Hospital, Shanghai Jiao Tong University from Jan. 2018 to Oct. 2019 were retrospectively collected. According to whether STAS happened, the patients were divided into STAS group and non-STAS group. Univariate analysis and binary Logistic regression analysis were used to analyze the risk factors of STAS in stage A lung adenocarcinoma between the two groups. Results: A total of 1 365 patients with stage A lung adenocarcinoma were included, including 1 312 patients without STAS and 53 patients with STAS. Univariate analysis showed that there were significant differences in gender and major subtypes of lung adenocarcinoma between the two groups (both P=0.000), but there was no significant difference in T stage between the two groups. Binary Logistic regression analysis showed that male and non-lepidic subtypes were independent risk factors. Conclusion: For the treatment of stage A lung adenocarcinoma, especially those with micropapillary subtype, the clinicians should pay attention to the possibility of STAS.
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Objective: We aimed to investigate the clinicopathology and prognosis of invasive micropapillary carcinoma (IMPC) of the breast. Methods: This was a single-center retrospective study based on the clinicopathological and follow-up data of 246 patients with IMPC who were treated at the Tianjin Medical University Cancer Institute and Hospital between January 2011 and December 2015. The patients were divided into two groups: we included 143 patients with >50% IMPC in group A and the remaining 103 patients in group B. The cox proportional-hazard regression model, Log-rank test, and Kaplan-Meier method were used for analysis. Results: The 5-year disease-free survival (DFS; 76.5% vs. 83.6%, P=0.042) and overall survival (OS; 74.1% vs. 81.6%, P=0.029) of group A were lower than those of group B. The DFS (χ2=5.219, P=0.022) and OS (χ2=3.96, P=0.047) of patients who did not receive radiotherapy in group A were lower than those of patients who received radiotherapy. Multivariate Cox regression analysis showed that HER-2 expression (HR= 2.989, 95% CI 1.400-6.384, P=0.005), mammilla invasion (HR=2.388, 95% CI 1.263-4.518, P=0.007), and ≥4 lymph node metastasis (HR= 2.076, 95% CI 1.080-3.992, P=0.029) were independent risk factors for DFS. Mammilla invasion (HR=1.951, 95% CI 1.054-3.609, P= 0.033) was an independent risk factor for OS. The DFS (χ2=6.541, P=0.011) and OS (χ2=6.455, P=0.012) in patients with mammilla invasion who did not receive radiotherapy were significantly lower than those of patients who received radiotherapy. Conclusion: As a special type of breast cancer, mammilla invasion indicates a poor prognosis. The prognosis of patients with >50% IMPC was worse than that of patients with ≤50% IMPC. Postoperative adjuvant radiotherapy may provide survival benefit to patients with IMPC accounting for 50% or mammilla invasion.
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Objective To analyze the prognostic influencing factors of pulmonary adenocarcinoma with a micropapillary pattern (MPPAC).Methods A total of 109 MPPAC patients who received surgical operation in Shandong Cancer Hospital Affiliated to Shandong University from August 2012 to August 2015 were retrospectively analyzed.The median survival time and the survival rate of 1-,3-and 5-year were calculated by using Kaplan-Meier method,log-rank test was used for single-factor analysis and Cox regression analysis was used for multiple-factor analysis.Results The median overall survival time of 109 MPPAC patients was 55.0 months (3-67 months).The overall survival rate of 1-,3-and 5-year was 89.0％,61.5％,48.6％,respectively.Single factor analysis showed that the gender (x2 =7.208,P =0.007),the tumor size (x2 =24.083,P ＜ 0.01),lymph node metastasis (x2 =23.068,P ＜ 0.01),vascular tumor thrombosis (x2 =16.411,P ＜ 0.01),visceral pleural infiltration (x2 =18.438,P ＜ 0.01) and multiple tumors (x2 =28.563,P ＜0.01) were associated with the overall survival of MPPAC patients.Multiple factor analysis showed that the tumor size (RR =1.629,95％ CI 1.145-2.317,P =0.007),lymph node metastasis (RR =1.680,95％ CI 1.161-2.430,P =0.006) and vascular tumor thrombosis (RR =2.867,95％ CI 1.286-6.392,P =0.010) were the independent prognosis factors for MPPAC patients.Conclusion The MPPAC patients have a poor prognosis.The tumor size,lymph node metastasis and vascular tumor thrombosis could influence the prognosis of MPPAC patients.
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Objective Studies are rarely reported on the factors influencing prognosis of surgically resected lung adenocarcinoma with a micropapillary pattern (LAC-MPP). This study aimed to explore the clinicopathological characteristics and risk factors of surgically resected LAC-MPP. Methods We retrospectively analyzed 384 cases of LAC treated in Henan Cancer Hospital between June 2015 and December 2017, which were classified into an MPP group (n = 82) and a non-MPP control group (n = 302) according to the results of postoperative pathology. We determined the expression of the fusion protein anaplastic lymphoma kinase (ALK), analyzed its association with the clinicopathological features of LAC-MPP, and explored the risk factors of postoperative MPP. Results Compared with the non-MPP group, the LAC-MPP patients showed a significantly higher expression of ALK (0.03% vs 12.20%, P < 0.05), rate of bronchial invasion (30.80% vs 48.78%, P < 0.05) and vascular tumor thrombus (0.99% vs 25.61%, P < 0.05), but a lower mutation rate of the epidermal growth factor receptor (EGFR) (64.24% vs 51.22%, P < 0.05). Multivariate logistic regression analysis revealed that the expression of ALK, vascular tumor thrombus, and age were significantly associated with the risk of postoperative MPP. Conclusion There is a high incidence rate of ALK expression in LAC-MPP patients after operation, which may provide some new ideas for the clinical treatment of the disease. Special attention should be paid to the expression of the ALK fusion protein and vascular tumor thrombus, and age in patients with LAC-MPP after operation.
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Objective To study the clinicopathological features of breast invasive micropapillary carcino-ma and its treatment and prognosis. Methods Clinical data, radiological examination, histopathology, immuno-histochemistry, therapeutic regimen and follow-up results of 16 cases of invasive micropapillary carcinoma of the breast were collected. The clinicopathological features, immunophenotype, imaging findings, treatment and progno sis were retrospectively analyzed. Results All the 16 cases were female, with mean age of 56.3 years(40 to 89 years). Of the 16 patients, 4 cases were pure invasive micropapillary carcinoma, and 12 cases were mixed invasive mi-cropapillary carcinoma. Among the 12 cases of mixed invasive micropapillary carcinoma, 1 case was mixed with invasive ductal carcinoma, mucinous carcinoma and invasive micropapillary carcinoma, and the remaining 11 cas-es were all non-specific invasive ductal carcinoma with invasive micropapillary carcinoma. Out of the 16 cases, 13 (81.25％) were invasive micropapillary carcinoma with axillary lymph node metastasis, axillary lymph node metas tasis which was more than 4 had 7 cases(43.75％), clinical stage Ⅲ had 8 cases(50％). According to the patho-logical results, 16 cases were treated with individualized comprehensive treatment. Of the 16 patients, 14 were fol-lowed up and 2 were lost. Conclusion Breast infiltrating micropapillary carcinoma is a rare type of breast can-cer, with high rate of axillary lymph nodes metastasis, aggressive lymphatic invasiveness, high malignancy degree and poor prognosis.
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Objective@#To study the clinicopathological features of breast invasive micropapillary carcinoma and its treatment and prognosis.@*Methods@#Clinical data, radiological examination, histopathology, immunohistochemistry, therapeutic regimen and follow-up results of 16 cases of invasive micropapillary carcinoma of the breast were collected. The clinicopathological features, immunophenotype, imaging findings, treatment and prognosis were retrospectively analyzed.@*Results@#All the 16 cases were female, with mean age of 56.3 years (40 to 89 years) . Of the 16 patients, 4 cases were pure invasive micropapillary carcinoma, and 12 cases were mixed invasive micropapillary carcinoma. Among the 12 cases of mixed invasive micropapillary carcinoma, 1 case was mixed with invasive ductal carcinoma, mucinous carcinoma and invasive micropapillary carcinoma, and the remaining 11 cases were all non-specific invasive ductal carcinoma with invasive micropapillary carcinoma. Out of the 16 cases, 13 (81.25%) were invasive micropapillary carcinoma with axillary lymph node metastasis, axillary lymph node metastasis which was more than 4 had 7 cases (43.75%) , clinical stage Ⅲ had 8 cases (50%) . According to the pathological results, 16 cases were treated with individualized comprehensive treatment. Of the 16 patients, 14 were followed up and 2 were lost.@*Conclusion@#Breast infiltrating micropapillary carcinoma is a rare type of breast cancer, with high rate of axillary lymph nodes metastasis, aggressive lymphatic invasiveness, high malignancy degree and poor prognosis.
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Objective: To investigate the prognosis of patients who receive neoadjuvant chemotherapy (NAC) for invasive micropapillary carcinoma (IMPC) of the breast using a propensity score matching (PSM) method and to analyze the effects of NAC. Methods: Clinical and pathological data of a total of 251 cases of IMPC of the breast were collected for this study, from January 2011 to March 2014 in Tianjin Medical University Cancer Institute and Hospital, of which the NAC group comprised 67 cases and the non-NAC group comprised 184 cases. Tumor sizes before and after NAC were compared in the NAC group. Prognostic differences were compared between the NAC group and non-NAC group before and after PSM balancing the baseline. Results: The mean value of the maximum dimensions significantly reduced from 5.0cm to 4.2cm in the NAC group after NAC (P=0.035), but there was no statistically significant difference in T stage changes (P=0.064). A total of 49 pairs of patients were matched after PSM, and differences in the baseline data of the paired group were not significant. Univariate survival analysis showed no significant difference in the recurrence-free survival (RFS) rate between the NAC group (77.6% vs. 89.2%) and non-NAC group (72.1% vs. 91.0%) before and after PSM (all P>0.05). The 5-year distant metastasis-free survival (DMFS) rates in the NAC group before and after PSM were 53.4% and 50.0%, respectively, which were both significantly lower than those in the non-NAC group 69.1%, 59.2% (all P<0.05), and multivariate survival analysis showed that undergoing NAC was an independent prognostic factor of DMFS after PSM. Conclusion: Breast IMPC is a special type of tumor that is not sensitive to chemotherapy. Although some tumors decrease after NAC, IMPC patients do not benefit from NAC in terms of RFS; NAC may even increase the risk of distant metastasis. Therefore, IMPC patients should undergo surgical treatment as soon as possible, and NAC is not recommended.
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Objective To investigate the clinical pathological characteristics and the prognosis of the invasive micropapillary carcinoma (IMPC) of breast cancer.Methods The clinical pathological characteristics of 47 IMPC patients treated in the Second Hospital of Jilin University from Jan.2010 to Dec.2016 were retrospectively analyzed.A long term survival has been followed.Results 47 IMPC patients were all female.The median age was 56(34-76) years old.The median diameter of the tumor was 1.9(0.8-7.0) cm.The rate of axillary lymph node metastasis was 66.7％ (30/44),the median number of axillary lymph node metastasis was 9.5 (1-55),and the metastasis number of 1 to 3 accounted for 43.3％ (13/30),the metastasis number of 4 to 9 accounted for 6.7％ (2/30),and the metastasis number more than 10 accounted for 50％ (15/30).The lymphatic invasion rate was 40.2％(39/97),and the skin and (or) the nipple invasion rate was 15.6％(7/45).The positive rate of ER,PR,HER2,E-Cadherin was 95.7％(44/46),91.3％(42/46),10.5％(4/38),100％(40/40),respectively.The tumor cell growth index marked by Ki-67 was 1％-80％,and 78.3％ patients' tumor cell growth index marked by Ki-67 were more than 20％.Conclusions IMPC is a relatively rare special type of breast cancer,which typically occurs at middle-aged and old female.The expression of ER,PR,E-Cadherin is high and the expression of HER2 is low.It has strong ability and high positive rate of lymph node metastasis,lymphatic invasion,and poor prognosis.
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Objective To investigate the clinicopathological features of early gastric cancer ( EGC) with micropapillary pattern. Methods In 447 consecutive EGC patients at Changzhou No. 2 People′s Hospital admitted from January 2006 to December 2016, 8 ( 1. 8％) with micropapillary adenocarcinoma (≥5％) were enrolled in the observation group and the remaining 439 were included in the control group. Clinicopathologic features including age, gender, gross pattern, tumor location, size, invasion depth, lymphovascular invasion, lymphatic metastasis and pathological stage were analyzed and compared between the two groups. Results There were no significant differences between the two groups in age, gender, gross pattern, tumor location or size (all P>0. 05). The observation group showed significantly more frequent submucosal invasion ( 100. 0％, 8/8 ) , lymphovascular invasion ( 62. 5％, 5/8 ) , lymphatic metastasis (62. 5％, 5/8), and higher pathological stage (Ⅱ+Ⅲ 25. 0％, 2/8) compared with those in the control group, which were 52. 4％ ( 230/439 ) , 9. 1％ ( 40/439 ) , 13. 9％ ( 61/439 ) , and 5. 9％ ( 26/439 ) , respectively ( all P<0. 05 ) . Conclusion EGC with micropapillary pattern is rare with a high liability to lymphovascular invasion, lymphatic metastasis, and higher pathological stage, compared to EGC without micropapillary pattern.
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Objective@#To elucidate the clinicopathological characters and prognostic factors of invasive micropapillary carcinoma of the breast (IMPC) by compared with invasive ductal carcinoma, not otherwise specified of the breast (IDC).@*Methods@#The retrospective study was performed with female patients who had undergone curative resection for breast cancer without neoadjuvant chemotherapy from June 2008 to April 2016 in Breast Center of Beijing Hospital. Forty-seven mixed or pure IMPC patients and 93 pure IDC patients(admitted in the same center from October 2008 to January 2016 ) were matched for tumor stage, nodal status and age. Follow-up was done every 3 to 6 months postoperatively. The deadline was July 31, 2016. The curves of disease free survival and overall survival were drawn by the Kaplan-Meier method, and survival rates were compared by means of the Log-rank test. Potential prognostic variables that were identified on univariate analysis were analyzed with Cox′s proportional hazards regression model for multivariate analysis. The χ2 test or Fisher′s exact test was used to compare distributions across 2 groups and the Mann-Whitney U test or t test was used to analyze the medians or means of 2 groups.@*Results@#With exact matches, the rates of lymphovascular invasion (LVI) (29.8% vs. 12.9%, χ2=5.885, P=0.015)and histological grade 3 (40.4% vs. 21.5%, χ2=-2.690, P=0.007) were both significantly higher in patients with IMPC than that in IDC group, but the survival between the two pathological types were not significantly different (all P>0.05). The percent of IMPC component didn′t influence the clinicopathologic characters (all P >0.05), but a significantly longer median disease free survival (χ2=11.731, P=0.001) when the patients had more than 50% of IMPC component was found.@*Conclusions@#Higher rates of LVI and histological grade 3 were found in IMPC than that in IDC, but the survival was comparable between the two groups. A longer DFS occurred in patients with IMPC component more than 50%.
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Objective To study the surgical safety of retained glands for micro?papillary thyroid carcinoma(mPTC). Methods A total of two hundred patients with mPTC from June 2012 to June 2016 in Seventh People's Hospital of Shanghai University of TCM were enrolled in this study: single follow?up group (group A,40 cases),unilateral total lobectomy+isthmus resection group(group B,85 cases),unilateral total lobectomy+contralateral lobe subtotal resection group( group C,45 cases) ,bilateral total lobectomy ( group D,30 cases) ,then the clinical outcome was compared. Results The average follow?up time was about 26. 5 months, and there was no significant increase in tumor diameter in group A ( (6. 6±1. 5) mm vs. (6. 5±1. 3) mm,t=0. 326,P=0. 621) . The incidences of hypothyroidism in group B and C were significantly lower than that in group D ( 7. 1％ vs. 30. 0％,χ2 =8. 366, P=0. 004, 11. 1％ vs. 30. 0％,χ2 =4. 230, P= 0. 040 ) , while the differences in hypoparathyroidism,hypocalcemia,laryngeal nerve injury and total rate among group B,C and D were not statistically significant(P>0. 05). The median survival times in group B,C and D were significantly longer than that in group A (42. 2months,43. 5months,43. 6months vs. 32. 8months,P<0. 05),while there was no significant difference among group B,C and D ( P>0. 05) . There was no statistically significant difference in 3?year tumor mortality and recurrence rates among the three groups ( P>0. 05 ) . Conclusion Unilateral lobe resection + isthmus resection + ipsilateral central lymph node dissection can maintain the gland function,reduce complications,without reducing the survival,it is worthy of popularization and application.
ABSTRACT
The incidence of thyroid cancer has increased, mainly due to the incidental finding of low-risk papillary thyroid cancers (PTC). These malignancies grow slowly, and are unlikely to cause morbidity and mortality. New understanding about the prognosis of tumor features has led to reclassification of many tumors within the low-risk thyroid category, and to the development of a new one “very low-risk tumors.” Alternative less aggressive approaches to therapy are now available including active surveillance and minimally invasive interventions. In this narrative review, we have summarized the available evidence for the management of low-risk PTC.