ABSTRACT
Objective To analyze the risk factors for abdominal lymph node recurrence after radical surgery in patients with middle thoracic esophageal squamous cell carcinoma (TE-SCC),and to design the target volume for postoperative radiotherapy based on the results.Methods A retrospective study was performed among 913 patients with middle TE-SCC undergoing radical surgery who were admitted to our hospital from 2007 to 2012.Influencing factors were analyzed for abdominal lymph node recurrence after treatment.The efficacy was compared between different treatment methods in the high-risk population.Comparison of categorical data was made by chi-square test.The overall survival rates (OS) were calculated by the Kaplan-Meier method and analyzed by the univariate log-rank analysis.The influencing factors for abdominal lymph node recurrence were analyzed by the multivariate logistic regression equation.Results After treatment,37 patients had abdominal lymph node recurrence,yielding a recurrence rate of 4.1％.A total of 53 recurrent sites were found.The univariate analysis showed that no/low differentiation,pT3+4 stage,no less than 3 positive postoperative lymph nodes,and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P =0.032,0.001,0.009,0.000).The multivariate regression analysis showed that pathological T staging and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P=0.011,0.000).For patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes,postoperative radiotherapy improved OS and local control rates but failed to reduce the distant metastasis-free rate.Conclusions T staging and positive postoperative abdominal lymph nodes are important risk factors for abdominal lymph node recurrence after radical surgery in patients with middle TE-SCC.Postoperative adjuvant therapy is recommended for patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes.
ABSTRACT
Objective To investigate the characteristics and risk factors of abdominal lymph node metastasis in thoracic esophageal squamous cell cancer.Methods The clinical data of 586 patients with thoracic esophageal cancer who underwent surgery via transabdominal and transthoracic approaches between June 2009 and June 2014 at the Sichuan Cancer Hospital were retrospectively analyzed.All the patients received resection of esophageal cancer and lymph node dissection, and the transabdominal right thoracic approach or cervico-thoracicabdominal triple incision was selected according to the condition of patients.No.18, 19, 20 lymph nodes were dissected seperately and No.16, 17 and lesser curvature lymph nodes were separated.All the specimens of lymph nodes were detected by regular pathological examination.Measurement data with normal distribution were presented as x ± s and count data were described as rate.Comparisons of rate between 2 specimens and among the multiple specimens were respectively analyzed using the chi-square test and partition of chi-squared.The multivariate analysis was done using the logistic regression.Results The number of lymph node dissected in 586 patients was 12 524 with an average number of 20 ± 11 per case, and the rate of lymph node metastasis was 55.63％ (326/586).The number of mediastinal lymph node dissected was 7 012 with an average number of 12 ± 5 per case, and a rate of mediastinal lymph node metastasis was 40.96％ (240/586).The number of abdominal lymph node dissected was 5 512 with an average number of 9 ± 8 per case, and a metastasis rate was 31.74％ (186/586).The abdominal lymph node metastasis rate of the upper, middle and lower thoracic esophageal cancer were 13.73％ (14/102), 31.51％ (92/292) and 41.67％ (80/192), respectively, showing a significant difference among the above 3 indexes (x2 =25.91, P ＜ 0.05).The lymph node metastasis rate in No.16, 17, 18,19, 20 and lesser curvature lymph nodes were 12.80％ (75/586), 16.89％ (99/586), 1.71％ (10/586),0.68％ (4/586), 1.71％ (10/586) and 2.05％ (12/586), respectively, with a significant difference among the above 6 indexes (x2 =287.95, P ＜ 0.05).The results of univariate analysis showed that the tumor location,surgical procedure, T stage, N stage, G stage, pathological stage and mediastinal lymph node metastasis were risk factors affecting abdominal lymph node metastasis of thoracic esophageal cancer (x2 =24.02, 23.97, 37.87,136.85, 38.79, 7.70, 154.27, P ＜ 0.05).The tumor in the lower thoracic portion, N3 stage and stage Ⅳ were independent risk factors affecting abdominal lymph node metastasis of thoracic esophageal cancer in the multivariate analysis (RR =5.80, 2.36, 2.76, 95％ confidence interval: 1.022-1.813, 1.317-3.950, 1.652-12.351, P ＜ 0.05).Conclusions Abdominal lymph node metastasis is common in thoracic esophageal cancer in which No.16 and 17 lymph nodes predominate, and it is easy to occur in patients with lower thoracic esophageal cancer, and advanced N stage and pathological type.
ABSTRACT
Objective To investigate the clinical effect of three-dimensional conformal radiotherapy combined with XELOX program chemotherapy for postoperative abdominal lymph nodes metastasis of gastric cancer.Methods Seventy-one patients with postoperative abdominal lymph nodes metastasis were divided by random digits table method into treatment group (36 cases) who treated with three-dimensional confomal radiotherapy combined with XELOX program chemotherapy and control group (35 cases) who treated with XELOX program chemotherapy.The short-term efficacy,the control rate of symptoms,the long-term survival rate and adverse reaction were observed in two groups.Results The complete remission rate and objective response rate in treatment group and control group were 36.1％(13/36),20.0％(7/35) and 77.8％(28/36),60.0％(21/35),respectively,there were significant differences between two groups (P ＜0.05).The overall control rate of abdominal pain,bloating,low back pain in treatment group was 80.6％ (29/36),significantly higher than that in control group [51.4％(18/35) ](P ＜ 0.01 ).Followed up for 2 years,the followed up rate waa 97.2％(69/71 ).The 1,2-year survival rates in treatment group and control group were 42.9％ (15/35),22.9％(8/35) and 20.6％(7/34),5.9％(2/34),respectively,and the median survival time was 11.6 months and 4.9 months,there were significant differences between two groups(P ＜ 0.01 ).The incicdence rates of bone marrow suppression and gastrointestinal tract in treatment group were obviously higher than those in controlgroup (P ＜ 0.01 ),and the symptoms all were improved after treatment.Conclusions Postoperative lymph nodes metastasis of gastric cancer is sensitive to concurrent chemoradiotherapy.Concurrent chemoradiotherapy can improve the short-term efficacy and prolong survival time,but the adverse reactions increase.
ABSTRACT
A case of extrapulmonary silicosis involving abdominal lymph nodes in a 62-year-old man is presented. The patient underwent subtotal gastrectomy and regional lymph nodes dissection for gastric adenocarcinoma of clinical stage III. On gross examination, two separate gastric adenocarcinomas and multiple enlarged lymph nodes mimicking metastatic lesion were noted. Microscopic examination of the enlaged lymph nodes revealed characteristic sclerohyaline silicotic nodules without metastatic adenocarcinoma. Chest roentgenogram showed diffusely scattered multiple tiny nodular lesions in the entire lung fields, particularly the posterior side of both upper lung fields. He had worked in a mine for 18 years and had been exposed to silica for 5 of those years. We report incidentally found, unusual case of extrapulmonary silicosis.
Subject(s)
Humans , Middle Aged , Adenocarcinoma , Gastrectomy , Lung , Lymph Nodes , Silicon Dioxide , Silicosis , ThoraxABSTRACT
The para-aortic lymph nodes are the most distal resectable intra-abdominal nodes, to which most lymphatic channels from the stomach converge. Metastasis of gastric cancer to these nodes is regarded as a distant metastasis, and the patient's prognosis is known to be dismal. The purposes of this study are to identify the frequency of metastasis in the para-aortic lymph nodes and to evaluate the therapeutic effect of dissection of these nodes in gastric cancer. Macroscopically identified para-aortic lymph nodes from the left renal vein to the aortic bifurcation were dissected during operation in 173 patients, from among all the patients who underwent surgery for gastric cancer at Kyungpook National University Hospital from 1990 to 1994. Metastases in the para-aortic lymph nodes were found in 26 cases (15%). The frequency of para-aortic lymph node metastasis increased significantly with increasing tumor size and Borrmann type. Neither the tumor location, the depth of invasion, nor the histologic type affected the frequency of metastasis. There were two operative mortalities (1.2%). Twenty-six patients (15%) remained hospitalized for more than 3 weeks postoperatively. There seemed to be a higher incidence of postoperative morbidity in patients with positive para-aortic lymph nodes than in patients with negative nodes, but this difference was not statistically significant. The five-year survival rate of patients with para-aortic lymph node metastasis was 14.4%. Among the patients with para-aortic lymph node metastasis, skip metastasis was found in 11 cases (42%). There seemed to be some survival advantage in patients with skip metastasis, as compared to the positive n3 cases. However, this was not a statistically significant difference. Dissection of the para-aortic lymph nodes did not cause any significant disadvantage in postoperative mortality and morbidity. However, it could not prevent peritoneal seeding or hematogenous metastasis. Based on these data, dissection of the para-aortic lymph nodes seems to have little therapeutic effect, but provides information for accurate staging.