Log odds of positive nodes as a prognostic factor for rectal cancer: a retrospective study

SUMMARY OBJECTIVE: Rectal cancer is an important cause of mortality and morbidity globally. The aim of this study was to investigate whether the log odds of positive nodes system is a better indicator than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis, which is an important cause of mortality and morbidity globally. METHODS: This was a single-center retrospective cross-sectional study. Data were obtained from the medical records of patients with rectum adenocarcinoma followed at Gazi University Hospital. The clinicopathological data of 128 patients with rectum adenocarcinoma who underwent low anterior resection or abdominoperineal resection between January 2010 and December 2018 was retrospectively reviewed. Patients with rectum adenocarcinoma as the first and only primary diagnosis, which was confirmed by histopathological examination, than those who had undergone complete curative resection via low anterior resection or abdominoperineal resection were included. Those with familial adenomatous polyposis or Lynch syndrome, those under 18 years of age, with a synchronous tumor, peritoneal spread, or metastatic disease at the time of diagnosis, and those with <12 lymph nodes dissected from the resection material were excluded from the study. RESULTS: In multivariate analysis, age, perineural invasion, tumor node metastasis stage, lymph node ratio stage, and log odds of positive nodes stage were found to be independent prognostic factors (p<0.05). LODDS2 patients' mortality rates were 9.495 times higher than LODDS0 patients [hazard ratio=9.495, (95%CI 4.155-21.694), p<0.001] while LNR2 stage patients' mortality rates were 7.016 times higher than LNR0 stage patients [hazard ratio=7.016, (95%CI 3.123-15.765), p<0.001] and N2 stage patients had a 5.135 times higher risk of mortality than those who were in N0 stage [hazard ratio=5.135 (95%CI 2.451-10.756), p<0.001]. CONCLUSION: Log odds of positive nodes is a more valuable prognostic factor for rectal cancer patients than tumor node metastasis and lymph node ratio systems to determine rectum cancer prognosis.

Analysis of survival time and benefits of postoperative radiotherapy in resected small cell lung cancer patients / 中华放射肿瘤学杂志

Objective:To analyze the survival time, prognostic factors and the value of postoperative thoracic radiotherapy in resected small cell lung cancer (SCLC) patients.Methods:Clinic opathological data of SCLC patients who received surgical treatment in Cancer Hospital & General Hospital of Ningxia Medical University from April 2014 to September 2021 were enrolled in this retrospective study. All patients were subject to follow-up. The survival time of SCLC patients was evaluated by Kaplan-Meier method. Univariate and multivariate analyses of prognostic factors were performed by Cox proportional hazard model.Results:A total of 64 patients with SCLC were enrolled in the study. The 5-year overall survival (OS) rate was 43.5%. Univariate analysis showed that TNM staging ( P=0.027), postoperative neutrophil-lymphocyte ratio (NLR) ( P=0.039) and adjuvant thoracic radiotherapy ( P=0.041) were the prognostic factors. Multivariate analysis showed that TNM staging ( P=0.038) and adjuvant thoracic radiotherapy ( P=0.022) were the prognostic factors in patients with SCLC. The 5-year OS rates of patients with and without adjuvant thoracic radiotherapy were 71.6% and 35.4% ( P=0.028), respectively. There was a statistically significant difference in the 5-year OS rates between pathological stage N 2 SCLC patients with or without adjuvant thoracic radiotherapy (75.0% vs. 0%, P=0.030). Conclusions:TNM staging and postoperative adjuvant thoracic radiotherapy are prognostic factors in patients with SCLC undergoing surgical treatment. Pathological stage N 2 SCLC patients can benefit from adjuvant thoracic radiotherapy.

The impact of multimodality integrated positron emission tomography-computed tomography on improving the staging and management of head and neck malignancy: a cross- sectional study

ABSTRACT BACKGROUND: Clinical assessment of head and neck cancers is highly challenging owing to the complexity of regional anatomy and wide range of lesions. The diagnostic evaluation includes detailed physical examination, biopsy and imaging modalities for disease extent and staging. Appropriate imaging is done to enable determination of precise tumor extent and involvement of lymph nodes, and detection of distant metastases and second primary tumors. OBJECTIVE: To evaluate the initial staging discrepancy between conventional contrasted computed tomography (CT) and 18F-fluorodeoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and its impact on management plans for head and neck malignancies. DESIGN AND SETTING: Prospective cross-sectional study in two tertiary-level hospitals. METHODS: This study included 30 patients with primary head and neck malignant tumors who underwent contrasted computed tomography and whole-body 18F-FDG PET/CT assessments. The staging and treatment plans were compared with the incremental information obtained after 18F-FDG PET/CT. RESULTS: 18F-FDG PET/CT was found to raise the stage in 33.3% of the cases and the treatment intent was altered in 43.3% of them, while there was no management change in the remaining 56.7%. 18F-FDG PET/CT had higher sensitivity (96% versus 89.2%) and accuracy (93% versus 86.7%) than conventional contrast-enhanced computed tomography. CONCLUSION: Our study demonstrated that 18F-FDG PET/CT had higher sensitivity and accuracy for detecting head and neck malignancy, in comparison with conventional contrast-enhanced computed tomography. 18F-FDG PET/CT improved the initial staging and substantially impacted the management strategy for head and neck malignancies.

Optimization of TNM staging and control of pathological quality in gastric cancer / 中华胃肠外科杂志

Comprehensive treatment of gastric cancer is mainly based on the pathological staging. The T stage mainly depends on the accurate determination of the depth of the tumor invasion. The accurate T stage should be standardized pathological examination and continuous sectioning. N stage may be influenced by the number of lymph node examined. Insufficient lymph node examined may lead to stage migration. Therefore, standardizing lymph node dissection and lymph node harvest after surgery is important. M stage is mainly to improve the detection rate of peritoneal lavage cytology (CY), identify high risk factors for peritoneal metastasis, and optimize the prediction of peritoneal metastasis molecular markers, as a complementary methods of clinical examination. Currently, the quality of standardized pathological diagnosis of gastric cancer in China still needs to be improved. This article mainly elucidates the related studies and clinical experience of our center on how to do better in the optimization of gastric cancer TNM staging and pathological quality control.

Clinical predictors of axillary lymph node metastasis in early breast cancer in Indian patients

Background: Surgical dissection is the accepted mode of staging the axilla in breast cancer. Proper prediction of axillary node positivity can help towards stratifying patients. The primary objective of the study was to assess the clinical factors influencing pathological axillary lymph node positivity in early carcinoma breast.Methods: This was a retrospective study, conducted at a tertiary cancer centre. Case records of all the patients with invasive breast cancer which are clinical T1 and T2 and either N0 or NI, from January 2011 to October 2014 were analysed. Clinical profile of the patient including age, BMI, comorbid, menstrual history, family history, symptoms, site of the lesion, size, single or multi centric origin were analysed.Results: Total of 608 patients of early breast cancer analysed of which 248 had pathological nodal positivity. The age group of 51 to 75 years, BMI ≥30, pre-menopausal patients had significant positive predictive value when compared to post-menopausal. Tumours in lower outer quadrant, central sector and multiple tumours also had positive predictive value. Clinical T2 when compared to clinical T1 stage and MRM when compared to BCS had significant positive predictive value.Conclusions: To conclude in present study age of the patient and clinical location of the tumour and surgery performed emerged as significant independent predictive factors of positive lymph node. Prospective studies are required to further prove the significance of these factors.

Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort

ABSTRACT Objective: The 8th TNM system edition (TNM-8) released in 2018 presents significant changes when compared to the 7th edition (TNM-7). The aim of this study was to assess the impact of changing the TNM staging criteria on the outcomes in a Brazilian cohort of differentiated thyroid carcinoma (DTC). Subjects and methods: DTC patients, attending a tertiary, University-based hospital, were classified by TNM-7 and TNM-8. Prediction of disease outcomes status of the two systems was compared in a retrospective cohort study design. Results: Four hundred and nineteen DTC patients were evaluated, comprised by 82% (345/419) women, with mean age at diagnosis of 46.4 ± 15.6 years, 89% (372/419) papillary thyroid carcinoma, with a median tumor size of 2.3 cm (P25-P75, 1.3-3.5). One hundred and sixty patients (38%) had lymph node metastases and 47 (11%) distant metastases at diagnosis. Using the TNM-7 criteria, 236 (56%) patients were classified as Stage I, 50 (12%) as Stage II, 75 (18%) as Stage III and 58 (14%) as Stage IV. When evaluated by the TNM-8, 339 (81%) patients were classified as Stage I, 64 (15%) as Stage II, 2 (0.5%) as Stage III and 14(3%) as Stage IV. After a median follow-up of 4.4years (P25-P75 2.6-6.6), the rate of incomplete biochemical and/or structural response was 54% vs. 92% (P = 0.004) and incomplete structural response was 42% vs. 86% (P = 0.009) for patients classified as stage IV by TNM-7 vs TNM-8, respectively. Only 4 (1%) disease-related deaths were recorded. Conclusions: In our cohort, 37% of DTC patients were down staged with the application of TNM-8 (vs. TNM-7). Additionally, TNM-8 seems to better stratify the risk of structural incomplete response at follow-up.

Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives

Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node status based on examination of a resected specimen is a key element of the current staging system and is also a crucial factor to determine use of adjuvant chemotherapy after surgical resection. However, the current tumor-node-metastasis (TNM) staging system only incorporates the number of metastatic lymph nodes in the N category. Numerous attempts have been made to supplement this simplified N staging including lymph node ratio, distribution of metastatic lymph nodes, tumor deposits, or extracapsular invasion. In addition, several attempts have been made to identify more specific prognostic factors in resected colorectal specimens than lymph node status. In this review, we will discuss controversies in lymph node staging and factors that may influence survival beyond lymph node status.

Discussion on pT3 staging in TNM staging of AJCC 8th edition gallbladder carcinoma / 中华外科杂志

Objective@#To discuss the rationality of stage pT3 in the AJCC 8th TNM criteria of gallbladder carcinoma.@*Methods@#A retrospective study was performed to analyze the clinical and pathological data of 88 patients with pT3 gallbladder carcinoma admitted to Department of Second Biliary Surgery of Eastern Hepatobiliary Surgery Hospital, affiliated to Naval Medical University from May 2013 to September 2018.pT3 stage tumors were divided into two groups: (1) pT3a stage: tumors had penetrated serosa but not directly invaded liver and/or an adjacent organ or structure; (2) pT3b stage: tumor penetrating serosa and directly invaded liver and/or an adjacent organ or structure. There were 45 patients with pT3a stage, including 15 males and 30 females, aged 36 to 80 years, with a median age of 59 years; 43 patients with pT3b, including 24 males and 19 females, aged 41 to 78 years old, median aged 63 years old.Patients with pT3a and pT3b were further divided into two groups respectively: radical resection group and extended radical resection group according to surgical radicalization. Independent sample t-test was used for comparison between two groups with normal distribution measurement data. Wilcoxon rank sum test was used between groups of non-normally distributed measurement data.The comparison of the count data was performed by χ2 test or Fisher exact probability method. Survival analysis was performed using Kaplan-Meier method, and survival rate was compared using Log-rank test.@*Results@#(1)Serum total bilirubin(15.6(90.3)mmol/L), albumin(40.2(4.8)mmol/L), and CA19-9(132.90(455.78)U/ml) levels in pT3b patients were higher than that in pT3a patients(10.2(6.8)mmol/L, 41.8(4.9)mmol/L, 14.35(36.27)U/ml), respectively(Z=-3.816, -1.966, -3.739, all P<0.05),postoperative complication rate in pT3b patients(24.4%) was higher than that in pT3a patients(8.9%)(P<0.05),postoperative hospital stay(12(7)days) and overall hospital stay((26±17)days) of pT3b patients were longer than that of pT3a patients((10±5) days and (19±7)days) (P<0.05). (2) The 1-, 3-, 5-year survival rates of pT3b and pT3a patients were 53%,22%,22% and 69%, 46%,38%,and the median survival time was 13 months and 26 months, respectively. The difference in survival rates between the two groups was statistically significant(χ2=5.117, P=0.024). (3)The 1-, 3-year survival rates of extended radical resection group(n=19) and radical resection group(n=24) in the pT3b stage were 73%, 36% and 28%, 7%, respectively.The survival time was 20 months and 9 months,respectively,and the difference in survival rates between the two groups was statistically significant(χ2=4.976, P=0.026).@*Conclusions@#pT3 gallbladder carcinoma could be further subdivided into pT3a stage and pT3b stage based on the TNM criteria of AJCC 8th gallbladder carcinoma. Extended radical resection for pT3b gallbladder carcinoma should be further considered after comprehensive assessment of the patient′s basic condition and surgical tolerance.

The effect of standardized lymphectomy and sampling of resected lymph nodes on TNM staging of resectable pancreatic head cancer / 中华外科杂志

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.

Correlations of serum CEA and CA19-9 levels with clinical staging of colorectal cancer / 预防医学

Objective To evaluate the value of serum CEA and CA19-9 concentration for clinical staging of colorectal cancer. Methods A total of 350 patients who underwent the surgical treatments for colorectal cancer between February 2015 to January 2017 were enrolled. The serum CEA and CA19-9 were detected by chemoluminescence method. Results The positive rate of CEA of patients in stageⅠto Ⅳ was 25.00%, 36.69%, 50.78% and 66.67%, respectively. The positive rate of CA19-9 of patients in stageⅠto Ⅳwas 2.94%, 10.07%, 17.97% and 53.33%, respectively. The positive rates of CEA and CA19-9 were gradually increased with the stage developing (P<0.05). Results from multivariate logistic regression analysis showed that the positive levels of CEA and CA19-9 were risk factors in the TNM staging of colorectal cancer. The ORs and 95%CI were 1.790 (1.163-2.755)and 3.476(1.790-6.749), respectively. Conclusion The positive serum concentrations of CEA and CA19-9 showed significant associations with TNM staging. Preoperative serum concentrations of CEA and CA 19-9 could be auxiliary diagnostic indicators to assess the condition of colorectal cancer.

Differences and comparison of prognostic evaluation between AJCC staging system 7th edition and 8th edition for gastric cancer (A report of 1 383 cases) / 中华消化外科杂志

Objective To compare the differences and clinical value of prognostic evaluation between American Joint Committee on Cancer (AJCC) TNM staging system 7th edition and 8th edition for gastric cancer (GC).Methods The retrospective case-control study was conducted.The clinicopathological data of 1 383 GC patients who were admitted to the First People's Hospital of Changzhou between January 2008 and August 2012 were collected.Distal gastrectomy,proximal gastrectomy + pyloroplasty or total gastrectomy were performed according to preoperative evaluation and intraoperative exploration.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations;(3) T staging comparison between AJCC TNM staging system 7th edition and 8th edition;(4) N staging comparison of AJCC TNM staging system 8th edition;(5) prognostic analysis in N staging of AJCC TNM staging system 8th edition;(6) TNM staging comparison between AJCC TNM staging system 7th edition and 8th edition;(7) prognostic analysis in different TNM staging between AJCC TNM staging system 7th edition and 8th edition.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to October 2017.Measurement data with normal distribution were represented as x ± s.Measurement data with skewed distribution were described as M (range).The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Results (1) Surgical and postoperative situations:1 383 GC patients underwent successful radical gastrectomy,including 923 with distal gastrectomy,165 with proximal gastrectomy and 295 with total gastrectomy.Of 1 383 patients,115 with postoperative complications were improved by symptomatic treatment,including 87 with surgical complications and 28 with non-surgical complications.Postoperative pathological examinations:total number of intraoperative lymph node dissection and number of lymph node metastasis were 25± 12 and 7±4;577 didn't have lymph node metastasis and 806 had regional lymph node metastasis;308 were in early GC and 1 075 in advanced GC.(2) Follow-up and survival situations:1 383 patients were followed up for 1-117 months,with a median time of 34 months.The 1-,3-and 5-year survival rates of 1 383 patients were respectively 90.5％,71.9％ and 61.1％.(3) T staging comparison between AJCC TNM staging system 7th edition and 8th edition:T staging definition between AJCC TNM staging system 7th edition and 8th edition was identical.T staging of 1 383 patients:308,192,65,628 and 190 were respectively detected in T1,T2,T3,T4a and T4b stagings.(4) N staging comparison between AJCC TNM staging system 7th edition and 8th edition:N staging definition between AJCC TNM staging system 7th edition and 8th edition was identical.N staging of 1 383 patients:577,255,207,230 and 114 were respectively detected in N0,N1,N2,N3a and N3b stagings.N3a and N3b were classified as N3 staging of AJCC TNM staging system 7thedition,but they were classified as independent staging of AJCC TNM staging system 8th edition.(5) Prognostic analysis in N staging of AJCC TNM staging system 8th edition:5-year survival rate of patients in N0,N1,N2,N3a and N3b stagings was respectively 85.6％,76.5％,59.4％,45.2％ and 32.5％ based on AJCC TNM staging system 8th edition,with a statistically significant difference in survival (x2 =394.400,P＜0.05).There was a statistically significant difference between N0 and N 1 stagings (x2 =45.630,P＜0.05),between N 1 and N2 stagings (x2 =19.470,P＜0.05),between N2 and N3a stagings (x2 =7.602,P＜0.05) and between N3a and N3b stagings (x2=13.020,P＜0.05).(6) TNM staging comparison between AJCC TNM staging system 7th edition and 8th edition:TNM staging of 366 patients had changes,including 2 in T1N3b staging,2 in T2N3b staging,18 in T3N3b staging,120 in T4aN2 staging,149 in T4aN3a staging,34 in T4bN0 staging and 41 in T4bN2 staging;364 were detected in staging Ⅲ in 7th edition and 8th edition,and sub-staging of staging Ⅲ had a change;2 in T1N3b of ⅡB staging were redistricted into Ⅲ B staging based on AJCC TNM staging system 8th edition.(7) Prognostic analysis in different TNM staging between AJCC TNM staging system 7th edition and 8th edition:according to 7th edition,cases and 5-year survival rate were respectively 247,89.5％ in Ⅰ A staging and 147,83.7％ in Ⅰ B staging and 77,75.9％ in ⅡA staging and 207,70.5％ in ⅡB staging and 136,61.0％ in ⅢA staging and 236,37.5％ in Ⅲ B staging and 333,35.4％ in Ⅲ C staging,with a statistically significant difference in survival among sub-stagings (x2 =228.800,P＜0.05).There was a statistically significant difference in survival among Ⅰ,Ⅱ and Ⅲ stagings (x2=189.000,P＜0.05) and between ⅢA and ⅢB or ⅢC stagings (x2=22.710,18.010,P＜0.05).There was no statistically significant difference in survival between Ⅰ A and Ⅰ B stagings (x2=0.179,P＞0.05),between Ⅱ A and Ⅱ B stagings (x2 =0.265,P＞0.05),and between Ⅲ B and Ⅲ C stagings (x2 =1.550,P＞0.05).According to 8th edition,cases and 5-year survival rate were respectively 247,89.5％ in Ⅰ A staging and 147,83.7％ in Ⅰ B staging and 77,75.9％ in Ⅱ A staging and 205,70.7％ in Ⅱ B staging and 288,53.8％ in ⅢA staging and 258,37.3％ in ⅢB staging and 161,28.5％ in ⅢC staging,with a statistically significant difference in survival among sub-stagings (x2=234.900,P ＜ 0.05).There was no statistically significant difference in survival between Ⅰ A and Ⅰ B stagings (x2 =0.179,P＞0.05) and between Ⅱ A and ⅡB stagings (x2 =0.564,P＞0.05).There was statistically significant differences in survival between Ⅲ A and Ⅲ B or ⅢC stagings (x2 =29.790,43.060,P＜0.05) and between Ⅲ B and Ⅲ C stagings (x2 =7.494,P＜0.05).Further analysis showed that changes of TNM staging system between 7th edition and 8th edition were in T3N3b,T4aN2,T4aN3a,T4bN0 and T4bN2 stagings,5-year survival rate in above stagings was respectively 16.7％,35.8％,30.2％,47.1％ and 26.8％,with statistically significant differences in survival between T3N3b and T4aN2,T4aN3a,T4bN0 and T4bN2 stagings (x2 =19.590,8.039,12.070,3.853,P＜0.05),between T4aN2 and T4aN3a,T4bN2 stagings (x2 =6.529,3.859,P ＜ 0.05),between T4aN3a and T4bN0 stagings (x2 =10.400,P＜0.05) and between T4bN0 and T4bN2 stagings (x2=4.636,P＜0.05).There was no statistically significant difference in survival between T4aN2 and T4bN0 stagings (x2 =3.607,P＞0.05) and between T4aN3a and T4bN2 stagings (x2 =0.029,P＞0.05).Conclusions Compared with AJCC TNM staging system 7th edition,N3a and N3b stagings are classified as independent staging in AJCC TNM staging system 8th edition,and 8th edition is more accurate in prognostic evaluation of GC patients in stage Ⅲ.

Predictive value of the plasma D-dimer levels on stage and response to chemotherapy of the pancreatic cancer / 中华消化外科杂志

Objective To investigate the predictive value of the plasma D-dimer levels on stage and response to chemotherapy of the pancreatic cancer (PC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 212 PC patients who were admitted to the Fudan University Shanghai Cancer Center between December 2016 and May 2017 were collected.Plasma D-dimer levels of 212 patients were measured,and relationship between plasma D-dimer levels and clinicopathological features or response to chemotherapy were analyzed.Observation indicators:(1) relationship between clinicopathological features and positive rate of plasma D-dimer before treatment;(2) relationship between response to chemotherapy and plasma D-dimer levels;(3) follow-up and survival situations.Follow-up using telephone interview was performed to detect survival of patients up to January 2018.Comparisons of count data were analyzed using chi-square test.Measurement data with skewed distribution were described as M (range).Results (1) Relationship between clinicopathological features and positive rate of plasma D-dimer before treatment:positive rate of plasma D-dimer before treatment was respectively 18.37％ (9/49),43.64％ (24/55),53.85％ (28/52),80.36％ (45/56) in patients with stage Ⅰ-Ⅱ A,ⅡB,Ⅲ and Ⅳ of TNM staging and 43.59％(17/39),24.62％(16/65) in patients with low-differentiated tumor and high-and moderate-differentiated tumor,with statistically significantly differences (x2 =41.454,4.051,P＜0.05).(2) Relationship between response to chemotherapy and plasma D-dimer levels:of 212 PC patients,108 received pathological diagnosis by endoscopic ultrasonography or liver puncture,and then underwent 4-6 cycles chemotherapy with gemcitabine.Of 108 patients,response to chemotherapy of 59 patients was partial remission or stable disease,plasma D-dimer level before treatment was increased in 39 patients (28 with reduced plasma D-dimer level after treatment) and normal in 20 patients;response to chemotherapy of 49 patients was progressive disease,plasma D-dimer level before treatment was increased in 34 patients (8 with reduced plasma D-dimer level after treatment) and normal in 15 patients.There was no statistically significant difference in proportion of patients with increased plasma D-dimer level before treatment (x2=0.132,P＞0.05),and there was a statistically significant difference in proportion of patients with reduced plasma D-dimer level after treatment (x2 =16.929,P＜0.05).(3) Follow-up and survival situations:212 patients were followed up for 3.5-12.0 months,with a median time of 7.5 months.During the follow-up,7 patients died and 205 had survival.Conclusion The plasma D-dimer level is significantly associated with TNM staging of the PC,tumor differentiation and response to chemotherapy.

Effect of high expression of Zwint on the proliferation of hepatoma cells and the prognosis of liver transplantation for hepatocellular carcinoma / 器官移植

Objective To investigate the expression of zeste white 10 interactor (Zwint) in primary hepatocellular carcinoma (HCC) and its effect on the prognosis of liver transplantation for HCC. Methods HCC tissues, paracancerous tissues and clinical data of 50 liver transplant recipients for HCC were collected. The expression levels of Zwint messenger RNA (mRNA) and Zwint protein in 20 pairs of HCC tissues and paracancerous tissues of 20 liver transplant recipients for HCC were compared using real-time fluorescence quantitative polymerase chain reaction (PCR), Western Blot and immunohistochemistry (IHC). Two HCC cell lines HepG-2 which interfered with the expression of Zwint successfully were selected as si-Zwint-1 group and si-Zwint-2 group, and the blank control was taken as si-NC group. The cell proliferation and cell cycle of various groups were compared using cell counting kit (CCK) -8 experiment, flat-cloning assay and cell cycle experiment. The consistency of the expression of Zwint and cyclin D1 in HCC tissues and cells was analyzed using Western Blot and IHC. The enrolled patients were divided into high expression group (22 cases) and low expression group (28 cases) based on the median of Zwint protein expression level, and the relationship of the expression level of Zwint protein and clinical characteristics, overall survival rate and disease free survival rate of liver transplant recipients for HCC was analyzed. Results The results of real-time fluorescence quantitative PCR showed that the expression level of Zwint mRNA in HCC tissues was higher than that of paracancerous tissues (P=0.03). The results of Western Blot and IHC showed that the expression level of Zwint protein in HCC tissues was higher than that of paracancerous tissues(both P<0.05).After the Zwint gene of HCC cell line HepG-2 was interfered,CCK-8 and flat-cloning assay showed that the cell proliferation potential was significantly weakened (all P<0.01), and the cell cycle arrested at stage G1(all P<0.05). The expression level of Zwint protein was closely related to tumor diameter and tumor, node, metastasis (TNM) staging (all P<0.05). The overall survival rate of liver transplant recipients for HCC in the high Zwint expression group was lower than that of the low expression group (P=0.02). Conclusions Zwint is highly expressed in HCC tissues, and it can promote the proliferation of HCC cells through regulating cell cycle. The expression level of Zwint is negatively correlated with the prognosis of liver transplantation for HCC.

Progress and prospect of TNM staging system of head and neck squamous cell carcinoma / 中国癌症杂志

The eighth edition of TNM staging system for head and neck squamous cell carcinoma has made several significant improvements on the basis of the previous one, which further increases its value in evaluating prog-nosis and guiding treatment strategies. However, results of some studies suggested that there's room for improvements in some respects. This article briefly summarized the major differences between the two editions, the remaining disad-vantages of the current system, the latest research progress and its potential development in the future.

Expression of Ang-2 and HSP90α in serum of patients with non-small cell lung cancer and its correlation with TNM staging / 国际检验医学杂志

Objective The expression of Ang-2 and HSP90α in serum of patients with non-small cell lung cancer and their correlation with TNM staging were analyzed.Methods From January 2015 to June 2016,40 patients with elderly non-small cell lung cancer and 40 healthy persons were selected as the study subjects.The serum levels of Ang-2 and HSP90 alpha in the subjects were examined and their correlation with the TNM stage of the patients was analyzed.Results Observation of Ang-2 and HSP90α levels in the serum of the patients group were significantly higher than the control group,and the difference was statistical significance(P<0.05);Serum Ang-2 and HSP90α levels TNM Ⅰ-Ⅱ patients were significantly lower than that of stage Ⅲ and Ⅳ,the difference was statistical significance(P<0.05);Serum Ang-2 and HSP90α levels in TNM Ⅲ patients was significantly lower than those in stage Ⅲ and Ⅳ,the difference was statistical significance(P<0.05);TNM staging was positively correlated with the levels of HSP90α in serum,and statistical significance(r=0.425,P<0.05),TNM stage had a remarkably positive correlation with the level of Ang in serum(r=0.525,P<0.05).Conclusion The levels of Ang-2 and HSP90α were significantly higher in the serum of elderly patients with non-small cell lung cancer,and the expression level was positively correlated with TNM stage.

The evaluation of different stages of TNM in prognosis of appendiceal neuroendocrine tumors / 天津医药

Objective To investigate the prognostic value of different stages of TNM in patients with appendiceal neuroendocrine tumors (NETs). Methods The clinical data of 40 cases of NETs were analyzed, and follow-up data were staged by the ENETS and AJCC TNM staging system. Kaplan-Miere survival curves were used to compare survival differences in patients with different stages of TNM. Results Of the 40 patients, no one was diagnosed as appendiceal NETs before surgery. Twenty-one patients were diagnosed as acute appendicitis, 16 were diagnosed as chronic appendicitis and 3 were suspected as appendiceal tumors due to thickening of the lumen before surgery. No clinical manifestations were found in 40 patients before surgery including diarrhea, abdominal pain, facial flushing, asthma-like seizures and other carcinoid syndrome performance. All patients underwent appendectomy, and appendix NETs were diagnosed by pathology after surgery. In 40 appendical NETs patients, 15 cases were classified as stageⅠ(37.5%), 10 cases were classified as stageⅡA (25%), 2 cases were classified as stageⅢA (5%), 13 cases were classified at stageⅢB (32.5%), and no patients were classified as stageⅣ. The median survival times (months) were 27, 22, 21 and 18 for patients with different stages, and there were no significant differences in survival times between four stages (χ2=0.8988,P>0.05). Conclusion The clinical features of appendical NETs are nonspecific. The diagnosis of appendical NETs is based on pathological examination and immunohistochemistry. There are no correlation between different TNM stages and prognosis of patients.

The evaluation of different stages of TNM in prognosis of appendiceal neuroendocrine tumors / 天津医药

Objective To investigate the prognostic value of different stages of TNM in patients with appendiceal neuroendocrine tumors (NETs). Methods The clinical data of 40 cases of NETs were analyzed, and follow-up data were staged by the ENETS and AJCC TNM staging system. Kaplan-Miere survival curves were used to compare survival differences in patients with different stages of TNM. Results Of the 40 patients, no one was diagnosed as appendiceal NETs before surgery. Twenty-one patients were diagnosed as acute appendicitis, 16 were diagnosed as chronic appendicitis and 3 were suspected as appendiceal tumors due to thickening of the lumen before surgery. No clinical manifestations were found in 40 patients before surgery including diarrhea, abdominal pain, facial flushing, asthma-like seizures and other carcinoid syndrome performance. All patients underwent appendectomy, and appendix NETs were diagnosed by pathology after surgery. In 40 appendical NETs patients, 15 cases were classified as stageⅠ(37.5%), 10 cases were classified as stageⅡA (25%), 2 cases were classified as stageⅢA (5%), 13 cases were classified at stageⅢB (32.5%), and no patients were classified as stageⅣ. The median survival times (months) were 27, 22, 21 and 18 for patients with different stages, and there were no significant differences in survival times between four stages (χ2=0.8988,P>0.05). Conclusion The clinical features of appendical NETs are nonspecific. The diagnosis of appendical NETs is based on pathological examination and immunohistochemistry. There are no correlation between different TNM stages and prognosis of patients.

Effect of radiation dose of dual-source computed tomography dual energy single-phase enhanced scan in patients with esophageal cancer: a perspective study / 中华消化外科杂志

Objective To investigate the eftect of radiation dose of dual-source computed tomography (CT) dual energy single-phase enhanced scan in patients with esophageal cancer.Methods The prospective study was conducted.The clinicopathological data of 56 patients with esophageal cancer who were admitted to the Lishui Hospital of Zhejiang University between January 2015 and December 2016 were collected.All the patients were divided into the experimental group (undergoing dual-source CT dual energy single-phase enhanced scan) and control group (undergoing dual-phase CT enhanced scan) bv randomised block method.TNM classification of esophageal cancer (Seventh Edition) published by American Joint Committee on Cancer (AJCC) was used as a standard TNM staging.Two observers independently read films.All the patients underwent radical resection of esophageal cancer or palliative surgery,and then received adjuvant radiochemotherapy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to March 2017.Observation indicators:(1) consistencies of T staging,N staging and M staging;(2) accuracies of T staging,N staging and M staging (pathological results as a gold standard);(3) radiation dose of CT scan;(4) treatment and follow-up situations.The Kappa test was used for evaluating the consistency,κ≥0.75 as a good consistency,0.40≤κ＜0.75 as a normal consistency and κ＜0.40 as a poor consistency.Comparisons of count data and ratio were done by the chi-square test.Comparisons of measurement data were analyzed by the t test.Results A total of 50 patients were enrolled in the study,including 25 in the experimental group and 25 in the control group.(1) Consistencies of T staging,N staging and M staging:all the 50 patients finished successfully CT scans.Two observers considered that consistencies of T staging,N staging and M staging in the 2 groups were normal (κ =0.452,0.618,0.729,P＜0.05).Consistencies of N staging and M staging were superior to T staging.(2) The pathological results were used as a gold standard.Accuracies of T staging,N staging and M staging in the experimental and control groups were 72％,76％ and 88％,84％ and 92％,88％,respectively,with no statistically significant difference between the 2 groups (x2 =0.10,0.37,0.50,P＞0.05).(3) Radiation dose of CT scan:volume CT dose index (CTDIvol),dose length production (DLP) and effective radiation dose (E) were (10.35±2.01) mGy,(400.63± 34.13) mGy · cm,(5.61 ± 0.47) mSv in the experimental group and (3.55 ± 0.60)mGy,(140.66± 10.89) mGy · cm,(1.98±0.17) mSv in the control group,respectively.There were statistically significant differences in CTDIvol and E between the 2 groups (t =16.23,36.30,P＜0.05).(4) Treatment and follow-up situations:of 50 patients,43 patients received treatments,including 32 undergoing radical resection (11 receiving postoperative adjuvant chemotherapy),6 undergoing palliative surgery,3 receiving single radiotherapy and 2 receiving single chemotherapy.Thirty-six of 43 patients were followed up for 3-18 months,with a median time of 6 months.During follow-up,1-year survival rate was 61.1％.Conclusion Dual-source CT dual energy single-phase enhanced scan in patients with esophageal cancer cannot reduce accuracy of TNM staging,but decreased effectively radiation dose.

Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center

PURPOSE: In patients with colorectal cancer, preoperative staging using various imaging technologies is important for establishing the treatment plan and predicting the prognosis. Although computed tomography (CT) has been used most widely, the versatility of CT accuracy was primarily because of the lack of specialization. In this study, we aimed to identify whether any advancement in abdominal CT accuracy in the prediction of local staging has occurred. METHODS: Between December 2014 and November 2015, patients with colorectal cancer were retrospectively enrolled. All CT findings were retrospectively reported. A total of 285 patients were included, and their retrospectively collected data were retrospectively reviewed, focusing on a comparison between preoperative and postoperative staging. RESULTS: The overall prediction accuracy of the T stage was 55.1%, with overstaging occurring in 63 (22.1%) and understaging in 65 patients (22.8%). The sensitivity and specificity were 90.0% and 68.4%, respectively. The overall prediction accuracy of the N stage was 54.7%, with overstaging occurring in 89 (31.2%) and understaging in 40 patients (14.1%). The sensitivity and specificity were 71.9% and 63.2%, respectively. The CT accuracies by pathologic stage were 0%, 62.2%, 25.3%, and 81.2% for stages 0 (Tis N0), I, II, and III, respectively. CONCLUSION: CT has good sensitivity for detecting colon cancers with tumor invasion beyond the bowel wall. However, detection of nodal involvement using CT is unreliable. In our opinion, abdominal CT alone has limitations in predicting the local staging of colorectal cancer, and additional technologies, such as CT plus positron emission tomography and/or colonography, will improve its accuracy.

Comparison of endoscopic ultrasonography and multislice spiral computed tomography for the preoperative staging of Borrmann typeⅣgastric cancer / 中国内镜杂志

Objective To compare the performances of endoscopic ultrasonography (EUS) and multislice spiral computed tomography (MSCT) in the preoperative staging of Borrmann type Ⅳ gastric cancer. Methods 48 patients involved in this study, all the patients had undergone surgical resection, Borrmann Type Ⅳ gastric cancer had con-firmed and evaluated by EUS and MSCT. Tumor staging was evaluated by Tumor-Node-Metastasis (TNM) staging. The results from the imaging modalities were compared with postoperative histopathological outcomes. Results The overall accuracies of EUS and MSCT for the T staging category were 54.2 % and 79.2 %( = 0.009), respectively. Stratified analysis revealed that the accuracy of MSCT in T3 and T4 staging was significantly higher than that of EUS ( = 0.032 for both). The overall accuracies of EUS and MSCT for the N staging category were both 56.3%. The sensitivity and specificity of EUS and MSCT in N staging were 83.3 %/72.2 % and 66.7 %/91.7 %, respectively. Conclusion MSCT prevail over EUS for Borrmann Type Ⅳ gastric cancer patients with invasion into serosal layer or adjacent organs or with distant metastasis.