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Objective: To explore the clinicopathological characteristics of lymph node-negative rectal neuroendocrine neoplasms (R-NENs). Methods: We retrospectively analyzed and regularly followed up the clinical and pathological data of 83 patients with lymph node-negative rectal NENs treated at China-Japan Friendship Hospital between December 2012 to December 2019. Results: Among the 83 patients, 49 (59%) were male and 34 (41%) were female with an average age of (43.3±11.4) years. Of the patients, 61 (75.5%) were mainly treated for nonspecific symptoms, 75 (90.4%) had a single tumor with an average size of (0.8±0.7) cm, 80 (96.4%) showed tumor infiltration into the mucosal and submucosal layers, and 65 (78.3%) predominantly had tumors of pathological grade G1. The average Ki-67 index was (2.1±1.7) %, with 78 (94%) patients having stage I tumors. Twenty-nine (34.9%) patients showed CgA positivity on immunohistochemical analysis. As for treatment, 67 (80.7%) patients underwent endoscopic resection, and 16 (19.3%) patients underwent surgery. The median follow-up time was 24 (3-90) months, with a 100% 5-year survival rate and relapse in 2 (2.4%) patients. Tumor recurrence was significantly correlated with the Ki-67 positive index (P=0.025), and tumor infiltration depth was correlated with the tumor diameter (P=0.03). Kaplan-Meier analysis showed that different treatment mode and tumor grade on prognosis and recurrence was statistically significant (Log-rank P=0.031, 0.001). Conclusions: Lymph node-negative rectal neuroendocrine neoplasms with a diameter >1 cm infiltrate the muscularis propria relatively easily and those ≤1 cm may also infiltrate the muscularis propria. It is recommended that all patients undergo ultrasound enteroscope (EUS) to determine the treatment choice. Endoscopic resection is the main treatment for lymph node-negative rectal neuroendocrine neoplasms. Patients with a high Ki-67 index are relatively prone to relapse after treatment.
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Objective To investigate the correlation between CT texture analysis and synchronous distant metastasis in patients with lymph node-negative colorectal cancer. Methods The preoperative CT images of 82 patients with lymph node-negative colorectal cancer were analyzed retrospectively.There were 12 patients with simultaneous distant metastasis and 70 patients without simultaneous distant metastasis.The maximum plane of the lesion on plain scan and portal CT images was analyzed by TexRAD software.When the spatial scaling factor(SSF)was 0 and 2-6,six texture parameters were obtained,and the differences of texture parameters between the two groups were compared.The counting data were analyzed by chi-square test and the measurement data by Mann-Whitney test. Results There was a significant difference in the skewness of SSF=3 between the simultaneous distant metastasis group and the non-synchronous metastasis group on plain CT scan(
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Humans , Colorectal Neoplasms/diagnostic imaging , Lymph Nodes/diagnostic imaging , Neoplasm Metastasis , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective: To evaluate central lymph node dissection (CLND) and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma (PTMC). Methods: Clinical data and neck lymph node metastasis of 187 PTMC patients treated by the same surgeon from October 2012 to November 2015 in Department of Endocrine Breast Surgery, First Affiliated Hospital of Chongqing Medical University were analyzed retrospectively. Results: Postoperative pathology inspection confirmed that 94 of the 187 patients were accompanied with lymph node metastasis in central region, and the metastasis rate was 50.2%. Furthermore, lymph node metastasis rate in central region was not associated with gender and age (P>0.05), but the metastasis rates of the patients with multifocal lesion, tumor diameter greater than 5 mm, capsular invasion, or tumor location in the lower third of thyroid lobe were higher (P<0.05). Twenty-two cases of the 69 patients who underwent CLND were confirmed to have lymph node metastasis in this region. When the number of lymph node metastases in the central region was greater than or equal to 2, the cases were accompanied by increased risk of lymph node metastasis in the cervical region (P<0.05). The diagnosis level of lymph node metastasis in central region by intraoperative frozen-section examination was relatively higher than current cervical lymph node-negative (cN0) standard (P<0.05), which had lower false negative rate (20.2%) than current cN0 standard (88.8%) and was highly consistent with the postoperative pathology in central lymph node metastasis diagnosis (K=0.765, P=0.000). Conclusion: PTMC has high lymph node metastasis rate in the central region. Regular CLND is recommended. Intraoperative frozen-section examination can accurately evaluate cervical lymph node metastasis to help guide operation scope of thyroid and cervical lymph nodes.
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Objective·To evaluate central lymph node dissection (CLND) and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma (PTMC).Methods· Clinical data and neck lymph node metastasis of 187 PTMC patients treated by the same surgeon from October 2012 to November 2015 in Department of Endocrine Breast Surgery,First Affiliated Hospital of Chongqing Medical University were analyzed retrospectively.Results · Postoperative pathology inspection confirmed that 94 of the 187 patients were accompanied with lymph node metastasis in central region,and the metastasis rate was 50.2％.Furthermore,lymph node metastasis rate in central region was not associated with gender and age (P＞0.05),but the metastasis rates of the patients with multifocal lesion,tumor diameter greater than 5 mm,capsular invasion,or tumor location in the lower third of thyroid lobe were higher (P＜0.05).Twenty-two cases of the 69 patients who underwent CLND were confirmed to have lymph node metastasis in this region.When the number of lymph node metastases in the central region was greater than or equal to 2,the cases were accompanied by increased risk of lymph node metastasis in the cervical region (P＜0.05).The diagnosis level of lymph node metastasis in central region by intraoperative frozen-section examination was relatively higher than current cervical lymph node-negative (cN0) standard (P＜0.05),which had lower false negative rate (20.2％) than current cN0 standard (88.8％) and was highly consistent with the postoperative pathology in central lymph node metastasis diagnosis (K=0.765,P=0.000).Conclusion· PTMC has high lymph node metastasis rate in the central region.Regular CLND is recommended.Intraoperative frozen-section examination can accurately evaluate cervical lymph node metastasis to help guide operation scope of thyroid and cervical lymph nodes.
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Objective:To explore the clinicopathological factors in node-negative colon cancer patients with synchronous liver metasta-ses and to improve the efficiency of follow-up and rate of early diagnosis for high-risk patients. Methods:Clinical data of 140 colon cancer patients who underwent operation from January 2008 to December 2012 in Beijing Cancer Hospital were analyzed. The high-risk variables associated with synchronous liver metastases were subjected to univariate and multivariate analyses. Results:Synchro-nous liver metastases developed in 13 out of the 140 node-negative colon cancer patients. Eight out of those 13 patients (61.5%) ex-hibited complications with incomplete colon obstruction, and 6 cases underwent surgical treatment for both primary tumor and liver metastases. Both univariate and multivariate analyses revealed that preoperative abnormal serum carcinoembryonic antigen levels (≥5 ng/mL) and vascular invasion were significant independent risk factors for synchronous liver metastases. Conclusion:The risk of syn-chronous liver metastases for colon cancer patients with negative lymph node is slightly high. Vascular invasion and abnormal preoper-ative CEA levels are significant independent risk factors for synchronous liver metastases. Specific examination of livers is necessary for the special cohort at the time of diagnosis or after operation to avoid misdiagnosis.
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Background and purpose:Pathological lymph node metastasis (LNM) is not rare in clinical lymph node negative (cN0) papillary thyroid carcinoma (PTC). The aim of this study was to investigate the risk factors of LNM, especially of high volume LNM (more than 5 metastatic lymph nodes) and contralateral central compartment LNM, in cN0 PTC.Methods:Medical records of 350 PTC patients (265 female, 85 male, 212 patients with solitary lesion in unilateral lobe) were reviewed. All operations of these patients were performed by one surgical team. The clinical pathological data were collected, and univariate and multivariate analysis was performed.Results:LNM was conifrmed in 138 patients (39.4%) and 20 patients had high volume LNM. In 169 patients with solitary lesion in unilateral lobe with total thyroidectomy and bilateral central neck dissection, 24 patients had contralateral metastasis (14.2%). In univariate analysis, tumor size (58.5% in >1 cmvs 33.6% in≤1 cm) and tumor with calcification in preoperational ultrasonography (43.7% withvs 31.7% without) showed signiifcant difference in prevelance of LNM. In multivariate analysis, tumor size >1 cm (OR=2.792) was the independent risk factor of LNM. Gender (3.8% in male vs 11.8% in female), age (10.7% 1 cmvs 3.4% in≤1 cm) and tumor with low echo in preoperational ultrasonography (13.9% withvs 4.8% without) showed signiifcant difference in univariate analysis of high volume LNM. Male (OR=5.152), tumor size >1 cm (OR=5.712) and age 1 cm (OR=3.863) were also demonstrated as independent risk factors of contralateral LNM in patients with solitary lesion in unilateral lobe, the prevalence of LNM were 26.5% in male and 26.1% in tumor size >1 cm, respectively.Conclusion:LNM was not “rare” in cN0 PTC patients. Prophylactic central neck dissection should be performed in cN0 patients with tumor size >1 cm. For cN0 microcarcinoma, more active surgical treatment may be considered in male and young patients.
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PURPOSE: To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. MATERIALS AND METHODS: Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. RESULTS: There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph node-positive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion, and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (> or =59, hazard ratio, 2.882), and carcinoembryonic antigen level (> or =5 ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3, hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. CONCLUSIONS: Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.
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Humans , Carcinoembryonic Antigen , Follow-Up Studies , Lymph Nodes , Multivariate Analysis , Recurrence , Stomach NeoplasmsABSTRACT
PURPOSE: To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. MATERIALS AND METHODS: Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. RESULTS: There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph node-positive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion, and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (> or =59, hazard ratio, 2.882), and carcinoembryonic antigen level (> or =5 ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3, hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. CONCLUSIONS: Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.
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Humans , Carcinoembryonic Antigen , Follow-Up Studies , Lymph Nodes , Multivariate Analysis , Recurrence , Stomach NeoplasmsABSTRACT
PURPOSE: Axillary lymph node metastasis is one of the most important prognostic factors in breast cancer. Previous reports show differences that clinicopathologic factors influence the systemic recurrence and survival in axillary lymph node negative breast cancer. Thus, we have attempted to determine the prognostic factors influence on the systemic recurrence and survival in axillary lymph node negative breast cancer. METHODS: We retrospectively reviewed the data of 1,351 node negative breast cancer patients who underwent curative surgery to determine the prognostic factors such as age, sex, body mass index (BMI), family history, bilateral breast cancer, operation method, tumor size, stage, histologic grade, number of resected lymph nodes, hormone receptor status, overexpression of p53 and c-erbB2, and adjuvant therapy that influence the systemic recurrence and 10-year-distant relapse-free survival. RESULTS: Systemic recurrence occurred in 58 patients (4.3%) during 53.3 months median follow up period. The tumor size (P=0.001), stage (P=0.005), histologic grade (P=0.049). ER (P=0.028), PR (P=0.002), overexpression of p53 (P=0.001) and bilateral breast cancer (P=0.043) were statistically significant factors that influenced the systemic recurrence. In multivariate analysis, only tumor size was associated with the systemic recurrence (P=0.003). Tumor size (P=0.004), histologic grade (P=0.035), ER (P=0.046), PR (P=0.001) and bilateral cancer (P=0.003) were statistically significant factors that influenced 10-year-distant relapse-free survival. CONCLUSION: The larger tumor size was determined to be an independent prognostic value in axillary lymph node negative breast cancer.
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Humans , Body Mass Index , Breast , Breast Neoplasms , Follow-Up Studies , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Recurrence , Retrospective StudiesABSTRACT
PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.
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Humans , Breast Neoplasms , Breast , Chemotherapy, Adjuvant , Classification , Consensus , Follow-Up Studies , Prognosis , Recurrence , Retrospective StudiesABSTRACT
PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.
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Humans , Breast Neoplasms , Breast , Chemotherapy, Adjuvant , Classification , Consensus , Follow-Up Studies , Prognosis , Recurrence , Retrospective StudiesABSTRACT
Purpose: To study the expression of MMP-2 in lymph node-negative breast carcinoma and its relation to other factors and its clinical value. Methods: Paraffin-embedded specimens from 270 patients with lymph node-negative breast carcinoma were studied. MMP-2 were investigated by immunohistochemical staining. Results: Positive staining for MMP-2 were observed in some breast carcinoma cells. Positive staining of MMP-2 was significantly related to higher tumor grade and larger tumor size but not ER, PR and other factors. It was also significantly associated with patients relapse free survival but not overall survival. Conclusions: MMP-2 is an unfavorable prognostic factor in lymph node-negative breast carcinoma patients and it is an important prognostic factor.
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BACKGROUND: Nm23 gene was identified by the hybridization between two murine melanoma cell lines which had low or high metastatic potential and was located in chromosome 17q22. A number of tumor cohort studies have shown an inverse relationship between the levels of expression of nm23 protein and disease aggressiveness and tumor metastatic potential. METHODS: In order to determine the significance of overexpression of the antimetastatic gene nm23 protein in human-lymph node-negative breast cancer and to compare it with established clinicopathologic prognostic factors such as the tumor size, histologic grades, TNM stages, and hormonal receptor status, we analyzed the nm23 protein expressions by immunohistochemical staining in 53 lymph-node-negative breast-cancer tissue specimens. RESULTS: The nm23 protein expression was positive in 35 cases (66%). There was no relationship between nm23 protein overexpression and menopause status, tumor size, histologic grade, and hormonal receptor status, but tumor stage correlated with nm23 protein overexpression. Also, overexpression of the nm23 protein was significantly correlated with a longer disease-free survival rate. CONCLUSION: Expression of nm23 protein may be of value for predicting the long-term disease-free survival rate in lymph-node-negative breast-cancer patients.