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Objective To investigate the prognostic factors of radical gastrectomy for stage Ⅲ gastric cancer and predictive value of metastatic lymph node ratio for prognosis.Methods The retrospective case-control study was conducted.The clinicopathological data of 995 patients with stage Ⅲ gastric cancer who were admitted to the Zhongshan Hospital of Fudan University between January 2003 and December 2014 were collected.There were 690 males and 305 females,aged from 20 to 75 years,with an average age of 61 years.After clinical staging according to results of preoperative accessory examinations,patients with early gastric cancer underwent D1+ lymphadenectomy,patients with advanced gastric cancer underwent D2 lymphadenectomy and patients with serosa invasion underwent D2+ lymphadenectomy.Observation indicators:(1) treatment situations;(2) follow-up and survival situations;(3) prognostic factors analysis after operation;(4) stratified analysis:① stratified analysis of tumor pathological N staging;② stratified analysis of number of lymph node dissected;③ stratified analysis of tumor pathological TNM staging;(5) receiver operating characteristic (ROC) curve.Patients were followed up using outpatient examination and telephone interview to detect postoperative survival up to January 2016.The overall survival time was from the operation data to last follow-up or time of death.Measurement data with normal distribution were represented as Mean±SD.The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method and Log-rank test was used for survival analysis.The COX proportional hazard model was used for univariate and multivariate analysis.The ROC curve and area under curve (AUC) were used to check the accuracy of number of positive lymph nodes and metastatic lymph node ratio for prognosis.Comparison of the AUC was analyzed by the Z test.Results (1) Treatment situations:of 995 patients underging gastrectomy,677 underwent distal gastrectomy,85 underwent proximal gastrectomy,233 underwent total gastrectomy.There were 117 undergoing D1+ lymphadenectomy and 878 undergoing D2 lymphadenectomy or D2+ lymphadenectomy.The number of lymph node dissected,number of positive lymph nodes,metastatic lymph node ratio were 27± 12,10± 9 and 0.41±0.28,respectively.(2) Follow-up and survival situations:995 patients were followed up for (35± 32)months.During the follow-up,the 1-,3-,5-year overall survival rates were 77.9％,47.8％,36.2％.(3) Prognostic factors analysis after operation:results of univariate analysis showed that sex,tumor histological type,vascular embolus,degree of tumor invasion,tumor pathological N staging,number of lymph node dissected,metastatic lymph node ratio,tumor pathological TNM staging were related factors affecting prognosis of radical gastrectomy for stage Ⅲ gasteric cancer (hazard ratio =0.817,1.486,1.268,2.173,1.957,1.737,3.357,2.169,95％ confidence interval:0.686-0.973,1.059-2.086,1.074-1.497,1.195-3.954,1.480-2.588,1.390-2.170,2.476-4.602,1.740-2.704,P＜0.05).Results of multivariate analysis showed that sex,tumor histological type,tumor pathological N staging,number of lymph node dissected,metastatic lymph node ratio,tumor pathological TNM staging were independent factors affecting prognosis of radical gastrectomy for stage Ⅲ gastric cancer (hazard ratio =0.805,1.476,0.237,1.475,3.811,3.600,95％ confidence interval:0.673-0.963,1.049-2.087,0.083-0.678,1.140-1.909,2.259-6.428,1.317-9.839,P＜0.05).(4) Stratified analysis:of the 995 patients,the postoperative l-,3-,5-year overall survival rates were 93.7％,69.6％,60.5％ in the patients with metastatic lymph node ratio ≤ 0.1,86.9％,60.6％,44.3％ in the patients with 0.1 ＜ metastatic lymph node ratio ≤0.4 and 64.3％,28.9％,21.0％ in the patients with metastatic lymph node ratio ＞ 0.4,showing a statistically significant difference (x2 =121.300,P＜0.05).There were statistically significant differences between patients with metastatic lymph node ratio ≤0.1 and patients with 0.1＜ metastatic lymph node ratio ≤0.4,between patients with metastatic lymph node ratio ≤0.1 and patients with metastatic lymph node ratio ＞0.4 (x2=7.580,65.320,P＜0.05).There was a statistically significant difference between patients with 0.1 ＜ metastatic lymph node ratio ≤0.4 and patients with metastatic lymph node ratio＞0.4 (x2 =80.806,P＜0.05).① Stratified analysis of tumor pathological N staging:the average metastatic lymph node ratio was 0.09 in the 132 stage N1 patients,who were divided into the patients with metastatic lymph node ratio ≤ 0.1 and ＞ 0.1.The postoperative 1-,3-,5-year overall survival rates were 92.2％,68.6％,59.1％ in the 108 patients with metastatic lymph node ratio ≤ 0.1 and 79.2％,32.8％,21.9％ in the 24 patients with metastatic lymph node ratio ＞0.1,respectively,showing a statistically significant difference (x2 =14.499,P＜0.05).The average metastatic lymph node ratio was 0.23 in the 265 stage N2 patients,who were divided into the patients with metastatic lymph node ratio ≤0.2 and ＞0.2.The postoperative 1-,3-,5-year overall survival rates were 92.3％,73.8％,61.0％ in the 138 patients with metastatic lymph node ratio ≤0.2 and 76.5％,40.1％,22.2％ in the 127 patients with metastatic lymph node ratio ＞0.2,respectively,showing a statistically significant difference (x2 =42.536,P＜0.05).The average metastatic lymph node ratio was 0.56 in the 598 stage N3 patients,who were divided into the patients with metastatic lymph node ratio ≤0.4 and ＞0.4.The postoperative 1-,3-,5-year overall survival rates were 88.5％,62.8％,47.0％ in the 194 patients with metastatic lymph node ratio ≤ 0.4 and 64.3％,29.8％,21.0％ in the 404 patients with metastatic lymph node ratio ＞0.4,respectively,showing a statistically significant difference (x2 =51.860,P＜ 0.05).② Stratified analysis of number of lymph node dissected:7 of 117 patients with the number of lymph node dissected ＜ 15 had metastatic lymph node ratio ≤0.1,who were divided into patients with metastatic lymph node ratio ≤0.4 and ＞0.4.The postoperative 1-,3-,5-year overall survival rates were 78.2％,40.0％,28.6％ in the 44 patients with metastatic lymph node ratio ≤0.4 and 78.1％,18.7％,12.9％ in the 73 patients with metastatic lymph node ratio＞0.4,respectively,showing a statistically significant difference (x2 =4.727,P＜0.05).③ Stratified analysis of tumor pathological TNM staging:of 262 patients with stage Ⅲa gastric cancer,the postoperative 1-,3-,5-year overall survival rates were 88.5％,65.0％,54.3％ in the 230 patients with metastatic lymph node ratio ≤0.4 and 77.5％,35.4％,29.5％ in the 32 patients with metastatic lymph node ratio ＞0.4,respectively,showing a statistically significant difference (x2 =6.132,P＜0.05).Of 296 patients with stage Ⅲb gastric cancer,the postoperative 1-,3-,5-year overall survival rates were 84.4％,60.7％,42.7％ in the 200 patients with metastatic lymph node ratio ≤ 0.4 and 59.9％,26.8％,21.7％ in the 96 patients with metastatic lymph node ratio ＞0.4,respectively,showing a statistically significant difference (x2 =23.699,P＜0.05).Of 437 patients with stage Ⅲ c gastric cancer,the postoperative 1-,3-,5-year overall survival rates were 84.7％,59.9％,38.7％ in the 133 patients with metastatic lymph node ratio ≤0.4 and 64.0％,27.9％,18.3％ in the 304 patients with metastatic lymph node ratio ＞0.4,respectively,showing a statistically significant difference (x2=36.215,P＜ 0.05).(5) ROC curve:ROC curves of postoperative overall survival rates in patients with stage Ⅲ gastric cancer were drawn using the number of positive lymph nodes and metastatic lymph node ratio,of which AUC were 0.619 (95％ confidence interval:O.588-0.649) and 0.706 (95％ confidence interval:0.677-0.734),showing a statistically significant difference (Z=8.842,P＜0.05).Conclusions Sex,tumor histological type,tumor pathological N staging,number of lymph node dissected,metastatic lymph node ratio,tumor pathological TNM staging are independent factors affecting prognosis of radical gastrectomy for stage Ⅲ gastric cancer.There is different prognosis of patients with different metastatic lymph node ratios in the subgroup of the same tumor pathological TNM staging,number of lymph node dissected,tumor pathological TNM staging.Compared with tumor pathological N staging,metastatic lymph node ratio has a more accurate predictive value for prognosis.
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Objective@#To examine the effect of standardized lymphectomy and sampling of resected lymph nodes (LN) on TNM staging of resectable pancreatic head cancer.@*Methods@#Consecutive patients with resectable pancreatic head cancer who received standard pancreatoduodenctomy at Department of General Surgery in Beijing Hospital from December 2017 to November 2018 were recruited as study group. After operation, the surgeon sampled lymph nodes from the fresh specimen following the Japanese Gastric Cancer Guidelines.Thirty-three cases were recruited in the study group and the mean age was (59.8±15.2) years.Pathologic reports from December 2015 to November 2016 were taken as control group, containing 29 cases with age of (57.0±13.0) years. Number of lymph nodes, standard-reaching ratio and positive nodes ratio were compared between two groups. According to the seventh edition and eighth edition of TNM staging, the changes of N staging and TNM staging were analysed. The quantitative data conforming to normal distribution were tested by independent sample t test, the quantitative data not conforming to normal distribution were tested by rank sum test, and the enumeration data were analysed by χ2 test.@*Results@#The basal data of the two groups were comparable (all P>0.05) . The number of lymph nodes sampled in the study group was 23.27±8.87, significantly more than in control group (12.86±5.90, t=0.653, P=0.000) .Ratio of cases with more than 15 nodes was 81.8% (27/33) in the study group and 34.5% (10/29) in the control group with statistical significance (χ2=14.373, P=0.000) . In the study group, the positive lymph node ratios of No. 17a+17b, 14a+14b, 8a+8p LN were 36.4% (12/33) , 30.3% (10/33) and 9.1% (3/33) respectively. The positive lymph node ratio in No.14a+14b LN was higher than in No.8 LN (χ2=4.694, P=0.030) . According to the change in N staging system in the AJCC eighth edition, 2 cases (6.1%, 2/33) changed from ⅠB to ⅡA, 7 cases (21.2%, 7/33) from ⅡA to ⅠB and 5 cases (15.2%, 5/33) changed from ⅡB to Ⅲ (25.0%, 5/20) .@*Conclusions@#No.14 LN should be treated as the first station rather than second station because of the anatomic character and higher metastatic ratio. Standardised lymphectomy and sampling may increase the number of LN resected and improve the TNM staging of resectable pancreatic head cancer.
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Objective To investigate the application value of the anatomical location of positive nodes (N staging) from TNM staging systems published by American Joint Committee on Cancer (AJCC) (7th edition),number of metastatic lymph nodes (NMLN),lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) as prognostic predictors in advanced gallbladder carcinoma(GBC).Methods The retrospective crosssectional study was conducted.The clinicopathological data of 176 patients who underwent radical resection of advanced GBC in the First Affiliated Hospital of Xi'an Jiaotong University between January 2008 and December 2014 were collected.According to preoperative assessment,intraoperative exploration and frozen section biopsy,staging and surgical procedure were confirmed.Observation indicators and evaluation criteria:(1) surgical and postoperative situations;(2) follow-up and survival situations;(3) N staging related indicators based on TNM staging systems of AJCC (7th edition):LNR =NMLN / total number of lymph node dissection,LODDS =Log (NMLN+0.5) / (total number of lymph node dissection-NMLN+0.5);(4) lymph node staging based on NMLN,LNR and LODDS:LODDS ＜-1.0 as LODDS 1 staging,-1.0 ≤ LODDS ＜ 0 as LODDS 2 staging,LODDS ≥0 as LODDS 3 staging;(5) prognostic comparisons of patients with different lymph node staging;(6) accuracy of 4 different types of lymph node staging predicting the prognosis of patients.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 31,2017.Measurement data with normal distribution were represented as x-±s.Measurement data with skewed distribution were described as M (range),and comparisons were done using the nonparametric test.The survival rate was calculated by the Kaplan-Meier method,and the Log-rank test was used for survival comparison.Correlation analysis was done using the Spearman correlation analysis,r ≥ 0.800 as a high correlation,0.500 ≤ r ＜ 0.800 as a moderate correlation and 0.300 ≤ r ＜ 0.500 as a low correlation.The receiver operating characteristic (ROC) curve and area under the curve (AUC) were respectively drawn and calculated based on 4 kinds of binary logistic regression model.Akaike information criterion (AIC) and Harrell concordance index (Harrell c-index) were respectively calculated based on 4 kinds of COX proportional hazard regression model.The larger values of AUC and Harrell c-index caused a smaller value of AIC,but a lymph node staging standard correlated with greater prognostic accuracy.Harrell c-index ＜ 0.50 was no prediction,and 0.50 ≤ Harrell c-index ≤ 1.00 was an obvious prediction.Results (1) Surgical and postoperative situations:176 patients underwent successful radical resection of GBC,including 161 in R0 resection and 15 in R1 resection,99 with D1 lymph node dissection and 77 with D2 lymph node dissection.Of 176 patients,9 with postoperative complications were improved by symptomatic treatment,including 6 with bile leakage,2 with hepatic dysfunction and 1 with intra-abdominal hemorrhage.Results of postoperative pathological examination:total number of lymph node dissection,NMLN and LNR were respectively 6.7±4.4,0 (range,0-12.0) and 0 (range,0-1.00);high-differentiated,moderate-differentiated and low-differentiated tumors were respectively detected in 16,81 and 79 patients;162 and 14 patients were in T3 and T4 stages;60 patients were combined with infiltration of the liver.(2) Follow-up and survival situations:176 patients were followed up for l-118 months,with a median time of 33 months.The 1-,3-and 5-year overall survival rates were respectively 63.1％,42.0％ and 32.0％.(3) N staging related indicators based on TNM staging systems ofAJCC (7th edition):95,45 and 36 patients were respectively detected in staging N0,N1 and N2.NMLN,LNR and LODDS were respectively 2.0 (range,1.0-7.0),0.40 (range,0.08-1.00),-0.15 (range,-0.99-1.04) in staging N1 and 4.0 (range,1.0-12.0),0.57 (range,0.13-1.00),0.11 (range,-0.70-1.04) in staging N2,with a statistically significant difference in NMLN (Z=-3.888,P＜0.05) and with no statistically significant difference in LNR and LODDS (Z=-1.492,-1.689,P＞0.05).(4) Lymph node staging based on NMLN,LNR and LODDS:NMLN and LNR as a cut-off point were respectively 4.0 and 0.70,NMLN 1 staging (NMLN=0) was detected in 95 patients,NMLN 2 staging (1.0 ≤ NMLN ≤ 4.0) in 61 patients and NMLN 3 staging (NMLN＞4.0) in 20 patients;LNR 1 staging (LNR=0) was detected in 95 patients,LNR 2 staging (0 ＜ LNR ≤ 0.70) in 58 patients and LNR 3 staging (LNR＞0.70) in 23 patients.LODDS 1,2 and 3 stagings was detected in 61,70 and 45 patients,respectively.The lymph node staging based on NMLN and LNR was significantly correlated with based on N staging of TNM staging systems of AJCC (7th edition) (r =0.949,0.922,P＜0.05);the lymph node staging based on LODDS was moderately correlated with based on N staging of TNM staging systems of AJCC (7th edition) (r =0.758,P＜ 0.05).(5) Prognostic comparisons of patients with different lymph node staging:1-,3-and 5-year overall survival rates were respectively 86.3％,65.3％,52.2％ in N0 staging patients and 44.4％,22.2％,13.3％ in N1 staging patients and 25.0％,5.6％,2.8％ in N2 staging patients,with a statistically significant difference (x2=88.895,P＜0.05).The 1-,3-and 5-year overall survival rates were respectively 86.3％,65.3％,52.2％ in NMLN 1 staging patients and 47.5％,19.7％,11.1％ in NMLN 2 staging patients and 0,0,0 in NMLN 3 staging patients,with a statistically significant difference (x2=121.086,P＜0.05).The 1-,3-and 5-year overall survival rates were respectively 86.3％,65.3％,52.2％ in LNR 1 staging patients and 41.4％,17.2％,11.8％ in LNR 2 staging patients and 17.4％,8.7％,0 in LNR 3 staging patients,with a statistically significant difference (x2 =86.503,P＜ 0.05).The 1-,3-and 5-year overall survival rates were respectively 85.2％,65.5％,51.8％ in LODDS 1 staging patients and 65.7％,40.0％,31.3％ in LODDS 2 staging patients and 28.9％,13.3％,5.9％ in LODDS 3 staging patients,with a statistically significant difference (x2=59.195,P＜0.05).(6) Accuracy of 4 different types of lymph node staging predicting the prognosis of patients:according to N staging of TNM staging systems of AJCC (7th edition),NMLN,LNR and LODDS,AUC,AIC and Harrell c-index of lymph node staging were respectively 0.878,0.881,0.870,0.864 and 1 047.5,1 026.4,1 044.2,1 063.6 and 0.77,0.78,0.77,0.76.AIC value was smaller with increased values of AUC and Harrell c-index based on NMLN,showing a greatest accuracy predicting the prognosis of patients.Conclusion Among N staging of TNM staging system of AJCC (7 edition),NMLN,LNR and LODDS as prognostic predictors,NMLN can more precisely predict radical resection of advanced GBC.
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@#Objective To evaluate the prognosis of different node status on the basis of the eighth TNM classification for lung cancer. Methods We retrospectively reviewed the clinical data of 1 851 non-small cell lung cancer (NSCLC) patients who underwent radical resection between January 2005 and December 2014. There were 1 078 males and 773 females at age of 16–86 (59.7±9.7) years. Survival probability was estimated by the Kaplan-Meier method and significance was assessed by the log-rank test. Results This cohort study was consisted of 1 209 patients with N0, 305 with N1 and 337 with N2. N0 patients were divided into a N0a group and a N0b group according to whether the 13 and 14 level of lymph nodes were examined. The survival rate of the N0a group was significantly higher than that of the N0b group, and the 5-year survival rate was 88.9% and 81.3% (P<0.001), respectively. According to the number of lymph node metastasis stations, N1 was divided into a N1a (single) group and a N1b (multiple) group. And no significant difference was observed between the two groups in survival rate (P=0.562). Based on the presence of lymph nodes of 10–12 level, N1 was divided into a negative group and a positive group. And the negative group was found with significantly higher survival rate than the positive group (5-year survival rate of 78.4% vs. 64.3%, P=0.007). The N2 patients were divided into a single station metastasis group (a N2a1 group), a single station with N1 positive group (a N2a2 group) and a multiple station group (a N2b group), and the percentage was accounted for 22.0% (74/337), 37.7% (127/337) and 40.3% (136/337), respectively. There was a statistical difference in 5-year survival rate (62.2% vs. 56.5% vs. 37.3%) among the three groups (P=0.001). Conclusion Subgroup analysis of N staging in NSCLC patients shows significant survival differences which may be more consistent with multidisciplinary therapy under precise staging patterns.
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Objective To investigate the accuracy of high-resolution magnetic resonance imaging (MRI) in diagnosis of the lymph nodes metastases (LNMs) and stage of rectal cancer (RC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 65 patients with RC who were admitted to the Peking University People's Hospital between April 2014 and April 2016 were collected.The results of postoperative pathological examination:of 65 patients with RC,24 had positive LNMs and 41 had negative LNMs;N0,N1 and N2 were respectively detected in 41,14 and 10 patients.Imaging data were captured using 3.0-Tesla MRI and body phased-array coil.Diagnostic criteria for LNMs of RC:criterion 1:irregular lymph node boundaries and signal characteristics were not considered;criterion 2:heterogeneous signal of lymph nodes and boundary characteristics were not considered;criterion 3:irregular lymph node boundaries and / or heterogeneous signal of lymph nodes.The American Joint Committee on Cancer (AJCC) cancer staging manual (7th edition) have established the N staging scheme for RC.Lymph nodes distribution according to the rectal lymphatic drainage:D1was located in fascia of the mesorectum;D1a above the level of tumor;D1b at the level of tumor;D1c under the level of tumor;D2 around the superior rectal artery and root of inferior mesenteric artery;D3 on the side of pelvic cavity.Observation indicators:(1) Efficiency and comparison of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria (postoperative pathological result as a gold standard).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRIaccording to the 3 criteria (postoperative pathological result as a gold standard).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC;②sensitivity,specificity,accuracy and consistency of LNMs diagnosed using different maximum short diameter of lymph nodes as a threshold (postoperative pathological result as a gold standard);③ comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold and using the 3 criteria;④ sensitivity,specificity,accuracy and consistency (postoperative pathological result as a gold standard) of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold combined with the highest efficiency in the (1),and its comparison in accuracy of LNMs with highest diagnostic accuracy as a threshold.(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria.(5) Follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' postoperative survival up to October 2016.The sensitivity,specificity,accuracy and comparison of ratio were respectively done by the chi-square test.Kappa test was used for consistency,tκ ≤ 0.40was used as low consistency,0.40＜κ≤0.60 as moderate consistency,0.60＜κ≤0.80 as higher consistency,and κ＞ 0.80 very high consistency.Results (1) Efficiency and comparison of LNMs of RC diagnosed by highresolution MRIaccording to the 3 criteria:accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 93.8％,87.7％ and 90.8％,showing very.high,higher and very high consistencies compared with postoperative pathological results (κ =0.87,0.74,0.81,P＜0.05),and with no statistically significant difference in diagnostic accuracy among them (x2=1.495,P＞0.05).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRI according to the 3 criteria:accuracies of N stage of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 87.7％,83.1％ and 84.6％,showing the same higher consistencies compared with postoperative pathological result (κ =0.77,0.68,0.72,P＜0.05),and with no statistically significant difference in N stage among them (x2=0.567,P＞0.05).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC:maximum short diameter ranges were respectively 3-18 mm in positive LNMs and 1-9 mm in negative LNMs,and maximum short diameter ＜3 mm and ≥ 10 mm were respectively negative and positive LNMs.② Efficiency of LNMs of RC diagnosed using different maximum short diameter of lymph nodes as a threshold:diagnostic accuracy of 70.8％was the highest when maximum short diameter ＞7 mm was used as a standard of positive LNMs,showing a low consistency compared with postoperative pathological result (κ =0.29,P＜0.05).③ Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold and using the 3 criteria:there was a statistically significant difference among them (x2 =15.637,P＜0.05);accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were higher than that diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold (x2 =10.354,5.656,6.923,P＜0.05).④Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm combined with the criterion 3 as a threshold and using maximum short diameter ＞7 mm as a threshold:the criterion 3 was used as a threshold because there was no statistically significant difference in diagnostic accuracy among the 3 criteria (P＞ 0.05).Diagnostic accuracy was 78.5％ when maximum short diameter ＞7 mm combined with the criterion 3 as a threshold,showing a low consistency compared with postoperative pathological result (κ =0.36,P＜0.05),with no statistically significant difference in diagnostic accuracy compared with maximum short diameter ＞ 7 mm as a threshold (x2=0.154,P＞0.05).(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria:positive LNMs of RC diagnosed by high-resolution MRI located mostly in D1 (76.1％-83.1％)and D1b(77.8％-81.4％).(5) Follow-up situations:of 65 patients,54 were followed up for 6-25 months,with a median time of 14 months.During the follow-up,7 patients had distant metastases and 47 had tumor-free survival.Conclusions There are higher accuracies of LNMs and N stage of RC diagnosed using preoperative highresolution MRI.Diagnostic accuracy of LNMs of RC cannot be improved when characteristics of lymph node morphology and size are used as a diagnostic standard.The positive LNMs of RC locate mostly in D1 and Dib.
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Objective To propose a new N staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy (IMRT) and Radiation Therapy Oncology Group (RTOG) guidelines for cervical lymph node levels.Methods A retrospective analysis was performed in 324 patients with newly diagnosed nasopharyngeal carcinoma who had no distant metastasis confirmed by pathology and received IMRT in the Department of Radiation Oncology in The First Affiliated Hospital of Guangxi Medical University from January 2010 to December 2011.They were restaged according to the 7thedition of UICC/AJCC staging system for nasopharyngeal carcinoma.The survival rates were estimated using the Kaplan-Meier method and the log-rank test was used for univariate prognostic analysis.The Cox proportional hazards model was used for multivariate prognostic analysis.Results Of 324 patients,269(83.0%) had lymph node metastasis.The median follow-up was 58 months (6-77 months).The 5-year overall survival,disease-free survival,relapse-free survival,and distant metastasis-free survival rates were 84.8%,77.1%,92.7%,and 80.5%,respectively.Univariate and multivariate analyses of patients with positive cervical lymph nodes revealed that retropharyngeal lymph node status,cervical lymph node level,and laterality were evaluated as independent prognostic factors for nasopharyngeal carcinoma.According to the hazard ratio calculated,the N staging system was revised as follows:N0:no regional lymph node metastasis;N1:VⅡ a or/and unilateral levels (I,Ⅱ,Ⅲ,Va) involvement;N2:bilateral levels (I,Ⅱ,Ⅲ,Va) involvement;N3:levels IVa,Vb,and IVb+Vc involvement.Conclusions The proposed N staging system is based on IMRT and RTOG guidelines for lymph node levels and more practical,and can provide highly objective prediction of outcome and guide treatment in nasopharyngeal carcinoma.
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Surgery is the first choice for the treatment of early non-small cell lung cancer(NSCLC),and lymph node metastasis is the most important factor influencing prognosis of resectable NSCLC.A large number of studies have identified the importance of systematic mediastinal lymph node(N2) dissection,which is also an important basis for the development of NCCN guidelines.But there are few reports about the dissection of intrapulmonary lymph node(N1),especially no detailed study on the dissection of the lymph nodes around the bronchi of non-primary tumor-bearing lobes and segments in lung cancer,and the NCCN guidelines were not detailed elaborate.This article will make a summary of the research on the correlation of intrapulmonary lymph node(N1) dissection.
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The current TNM staging including N staging has been suggested as a gold standard for the appropriate therapy in the well differentiated thyroid cancer patients. N staging was established based on histopathologic findings, however, the newly suggested prognostic factors for the revision of N staging include some clinicopathologic factors, such as clinical metastasis (macrometastasis), large node metastasis (> or =3 cm), extranodal extension and the number of metastatic node. Recently, American Thyroid Association reported the possibility that the low-risk group patients would be overestimated as high-risk group patients that leads to the overtreatment, the following unnecessary complication and the economic cost. The preexisting N1a/N1b classification by anatomical location of metastatic node still remains as a strong prognostic factor; however, many evidences indicated that the clinicopathologic factors described above should be considered in the risk stratification in the near future. Thus, it needs to be stressed that the four factors of micrometastasis, large node metastasis (> or =3 cm), gross or microscopic extranodal extension and multiple metastatic node (>5 cm) have been established as negative or positive prognostic factors and should be noted in clinical practice.
Subject(s)
Humans , Neoplasm Metastasis , Neoplasm Micrometastasis , Neoplasm Staging , Thyroid Gland , Thyroid NeoplasmsABSTRACT
BACKGROUND: Despite the technical developments in diagnosis and therapy, esophageal cancer is highly lethal disease and the survival is largely dependent upon the stage of the disease. Preoperative cancer staging is crucial in choosing a therapeutic option as well as in predicting the prognosis of the patients. Staging has been based on computerized tomography (CT) and transabdominal ultrasonography. However CT has a limit in pre-cisely discriminating the depth of invasion or the lymph node metastases. With the devel-opment of endoscopic ultrasonography (EUS) and with its superiority in delineating wall structure and detecting lymph node metastases, its usefulness in staging for esophageal cancer has been cknowledged. In order to evaluate the accuracy of EUS, we compared EUS with pathologic findings in patients with esophageal carcinoma. METHODS: From July 1990 to August 1997, 136 patients with esophageal cancer received preoperative cancer staging with EUS. Among them, 48 patients who underwent surgical procedures with the intention of radical resection were included. We compared the EUS and pathologic find-ings and analysed the accuracy of EUS for preoperative staging. RESULTS: The overall accu-racy of EUS for T-staging was 43.8%. Twenty five percents of the patients (12/48) pre-sented high-grade tumor strictures, which precluded the passage of the endoscope. There was no statistical significance according to tumor site, size or gross morphology. However theaccuracy was significantly lower in tumors with ulceration than in tumors without ulceration (35.3% vs 64.3%, p=0.004). Mainly, ulceration in tumors caused significant overstaging of the T-stage. In the assessment of regional lymph node metastasis, the overall accuracy achieved by EUS was 66.6%; the sensitivity was 95.5%, specificity 42.3%, positive predictive value 58.3%, and negative predictive value 91.7%. Tumors with more than 2 lymph nodes rendered more accurate N-staging than tumors with less than 2 lymph nodes. CONCLUSIONS: In conclusion, the accuracy of the EUS for preoperative staging of esophageal cancer was not satisfactory, mostly influenced by ulceration in tumors and its resultant inflammatory reactions around the tumors, therefore more systematic study will be needed to establish the precise diagnostic criteria of EUS staging.