Association of sonographic features and clinicopathologic factors of papillary thyroid microcarcinoma for prevalence of lymph node metastasis: a retrospective analysis

ABSTRACT Objective: The objective of the study was to develop an association between clinicopathologic and sonographic features of patients with papillary thyroid microcarcinoma and the prevalence of lymph node metastasis. Subjects and methods: Clinicopathologic and sonographic features of 415 patients of papillary thyroid microcarcinoma with (n = 102) or without (n = 313) lymph node metastasis were retrospectively reviewed. The thickness of the lymph node ≥ 6 mm with intra-lymph nodal occupying lesions considered lymph node metastasis. Also, it was considered metastasis if lymph node perfusion or blood flow defect was found with any thickness size. Univariate following multivariate analysis was performed for the prediction of sonographic features and clinicopathologic factors for the prevalence of lymph node metastasis. Results: Male gender ( p = 0.041), age < 45 years ( p = 0.042), preoperative calcitonin > 65 pg/ mL ( p = 0.039), nodule size > 5 mm in diameter ( p = 0.038), bilaterality ( p = 0.038), tumor capsular invasion ( p = 0.048), cystic change ( p = 0.047), and hyper vascularity ( p = 0.049) of thyroid nodules were associated with lymph node metastasis. Also, thyroid nodules 5 mm and more in diameter may have high aggressiveness. Conclusion: These data helped the surgeon for individualized treatment in thyroid carcinoma and avoid unnecessary prophylactic surgery of the lymph node.

Correlation of TLR3 with the alteration of stromal cells in tumor microenvironment of hepatocellular carcinoma / 临床与实验病理学杂志

Purpose To analyse the correlation between the Toll-like receptor 3 (TLR3) expression and clinic pathologic factors,stromal microenvironment in hepatocellular carcinoma (HCC).Methods The tissue microarrays of human HCC were prepared with self-owned patent technology.The expression of TLR3 in HCC cells as well as various indexes in HCC stroma was examined with immunohistochemistry of SP.The correlation between TLR3 expression with the clinic pathologic factors of HCC,and the correlation between TLR3 expression with the reaction of stromal cells in HCC microenvironment were analyzed by multi-factor correlation analysis.Results The positive expression rate of TLR3 in HCC was 71.57％.The expression of TLR3 in HCC had negative correlation with vascular invasion (P =0.001),cirrhosis (P =0.007),Edmondson's grades (P =0.001) and staging of TNM (P =0.000).It had positive correlation with hepatitis B surface antigen (HBsAg) (P =0.000).It had positive correlation with T cells (P =0.002) and natural killer (NK) cells (P =0.000).It had negative correlation with carcinoma-associated fibroblasts (CAFs) (P =0.000) and microvessel density (MVD) (P =0.000).Conclusion TLR3 has an important influence on the interstitial microenvironment of HCC.

A meta-analysis reveals prognostic role of programmed death ligand-1 in Asian patients with non-small cell lung cancer / 华中科技大学学报（医学）（英德文版）

Accumulating studies explored the clinicopathologic and prognostic value of programmed death ligand-1 (PD-L1) in non-small cell lung cancer (NSCLC), but the results were controversial. We therefore conducted a meta-analysis to evaluate the predictive role of PD-L1 in NSCLC patients. We systematically collected relevant studies from PubMed, Embase, Web of Science and China National Knowledge Infrastructure. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS), and odd ratios (ORs) with 95% CIs for clinicopathologic factors were calculated. A total of 15 studies involving 3605 patients were included in this meta-analysis. The results showed no prognostic role of PD-L1 in the whole patients (HR=1.60, 95% CI: 0.88-2.89, P=0.123). Subgroup analysis showed that PD-L1 was associated with decreased OS in Asian patients (HR=2.00, 95% CI: 1.55-2.57, P<0.001). Among all the clinicopathologic factors, PD-L1 overexpression was significantly in relevance with poor tumor cell differentiation (HR=1.84, 95% CI: 1.49-2.28, P<0.001), late stage (HR=1.21, 95% CI: 1.02-1.43, P=0.026) and anaplastic lymphoma kinase (ALK) translocation (HR=2.63, 95% CI: 1.08-6.40, P=0.034), but not with other factors. In conclusion, our meta-analysis demonstrated that PD-L1 has a prognostic role in Asian patients with NSCLC.

Tumor-infiltration of T-lymphocytes is inversely correlated with clinicopathologic factors in endometrial adenocarcinoma

OBJECTIVE: The aim of this study was to determine the distribution of T-lymphocytes and their relationship with clinicopathologic factors in endometrial carcinoma. METHODS: Samples were collected from 89 patients with endometrial endometrioid adenocarcinoma treated in Pusan National University Hospital from 2004 to 2011. Normal endometrial tissues were obtained from 30 hysterectomized women with benign adnexal masses and served as controls. Paraffin-embedded sections were immunohistochemically stained for CD8 (cytotoxic) and CD4 (helper) T-lymphocytes. The relationship of these cells with stage, histological grade, myometrial invasion, and lymph node metastasis was analyzed. RESULTS: The proportion of CD8+ and CD4+ lymphocytes in the endometrial endometrioid adenocarcinoma tissues was 67.4% (60/89) and 44.9% (40/89), respectively, which was significantly higher (P<0.05) than in the control group. The extent of CD8+ lymphocyte expression was negatively correlated with histologic grade, myometrial invasion, and lymph node metastasis. The proportion of infiltration of the CD4+ lymphocytes was negatively correlated with histologic grade and myometrial invasion. CONCLUSION: The high rate of infiltration of T-lymphocytes was negatively correlated with histologic grade, myometrial invasion, and lymph node metastasis. Our findings suggest that tumor-infiltrating T-lymphocytes may be used as pathologic prognostic factors in endometrial carcinoma.

Association of BRAF(V600E) Mutation with Poor Clinical Prognostic Factors and Ultrasonographic Findings in Cases of Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: This study evaluated the association of the BRAF(V600E) mutation with known prognostic factors and ultrasonographic characteristics in cases of papillary thyroid carcinoma. METHODS: Subjects included 169 patients who received thyroidectomy at Wonju Christian Hospital under the diagnosis of papillary thyroid cancer from February 2010 to October 2011. RESULTS: Of the total patients who received thyroidectomy, there were 128 cases (75,7%) of BRAF(V600E) mutation. Neither age nor sex were associated with the BRAF(V600E) mutation. Tumor size, shape, margin, extrathyroidal extension, central node metastasis and lateral node metastasis were found not to be associated with the BRAF(V600E) mutation. Tumor calcification, echogenicity and vascularity were also not associated with the mutation. CONCLUSION: As debate remains about the association between the BRAF(V600E) mutation and clincopathologic factors and ultrasonographic characteristics in cases of papillary thyroid carcinoma, further study is needed.

Prognostic Factors and Clinicopathologic Features after Resection of Small Hepatocellular Carcinoma (< or =2 cm)

PURPOSE: Hepatectomy has been regarded as the first treatment of choice for small hepatocellular carcinoma. However, hepatectomy for treatment of small hepatocellular carcinoma remains a critical issue. This study evaluates the role of treatment regarding the survival rate and clinicopathological features after resection of small hepatocellular carcinoma ((< or =2 cm) METHODS: This retrospective study was based on the medical records of 48 small hepatocellular carcinoma (< or =2 cm) patients who received surgical hepatectomy from 1990 to 2005. Patients who revealed on postoperative pathologic reports were enrolled. The survival rate was analyzed according to clinicopathologic and therapeutic factors and we analyzed the pathologic features of the recurrence group. RESULTS: The presence of liver cirrhosis, ICGR15 (Indocyanine green retension-15) was statistically significant in the univariate analysis. The vascular invasion rate and capsule formation rate was 90, 80% in the recurrence group. CONCLUSION: In the small hepatocellular carcinoma ((< or =2 cm), the presence of liver cirrhosis, ICGR15 (Indocyanine green retension-15) should be checked to predict prognosis. The small hepatocellular carcinoma ((< or =2 cm) is similar to advanced hepatocellular carcinoma so hepatectomy may play an important role in the small hepatocellular carcinoma ((< or =2 cm).

Bilaterality of Papillary Thyroid Carcinoma: Analysis of Clinicopathologic Factors and the Value of Preoperative Ultrasonography / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. The extent of the initial surgical treatment for PTC is still controversial and the bilaterality of PTC is an important factor for determining the extent of surgical resection. The aim of this study was to analyze clinicopathologic factors and the value of preoperative ultrasonography (PU) for bilateral tumor. METHODS: We retrospectively reviewed clinicopathologic factors and PU findings of 91 patients who underwent total thyroidectomy for PTC at the Dongguk University Ilsan Hospital from January 2006 to April 2009. RESULTS: Of the 91 patients, 28 (30.7%) had bilateral PTC in postoperative pathology. Of these 28 patients, only 18 patients (64.3%) were checked for bilateral PTC by PU findings and fine needle aspiration cytology. Sensitivity and specificity for bilaterality of PTC were 64.3% and 85.7%, respectively. The presence of benign nodules or malignant nodules in the same lobe in PU (P=0.008) and post-operative pathology (P=0.014) were statistically correlated with bilaterality. CONCLUSION: For the surgical care of PTC, bilaterality must always be considered, even though the tumor is diagnosed unilateral small PTC. PU in PTC patients has limited diagnostic value for bilateral PTC.

Factors Contributing to the Outcome in Adult Patients with Idiopathic Membranous Glomerulonephritis: Single Center Study in Korea / 대한신장학회잡지

The 70 adult patients with idiopathic membranous glomerulonephritis(IMGN), in whom renal biopsy has been performed at Keimyung University Dongsan Hospital, between January 1982 and December 1995 were studied for the clinical evolution of the disease and factors which might be involved in the development of chronic renal failure. There was 41 males and 29 females with a mean age of 41 years. Mean time from the onset to the renal biopsy was 13 months. The clinical presentations at the time of diagnosis were nephrotic syndrome(61.4%), asymptomatic urinary abnormality(21.4%), acute nephritic syndrome(14.3%), and recurrent gross hematuria(2.9%). During the mean follow-up period of 40+/-31 months, eleven(15.7%) of the patients developed chronic renal failure and five of them had end-stage renal disease. Five and ten years renal survival were 81.2% and 66.4%, respectively. In univariate analysis of clinical prognostic factors for progression to renal failure using Kaplan-Meier method, four parameters ; serum creatinine >or=1.4mg/ dL(p=0.011), hypoalbuminemia 2.5g/dL(por=10.0g/day(p=0.036) and remission of proteinuria < 2.0g/24hr (p<0.01) were found to have predictive value. No effect was observed in the age, sex, steroid and/or immunosuppressive therapy, hypertension and serum total cholesterol concentration on prognosis. In univariate analysis of pathologic prognostic factors, interstitial fibrosis(p=0.036) and inflammation(p=0.011) were significant for predictive value.