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Introducción. La gastrectomía y disección ganglionar es el estándar de manejo para los pacientes con cáncer gástrico. Factores como la identificación de ganglios por el patólogo, pueden tener un impacto negativo en la estadificación y el tratamiento. El objetivo de este estudio fue comparar el recuento ganglionar de un espécimen quirúrgico después de una gastrectomía completa (grupo A) y de un espécimen con un fraccionamiento por grupos ganglionares (grupo B). Métodos. Estudio de una base de datos retrospectiva de pacientes sometidos a gastrectomía D2 en el Servicio de Cirugía gastrointestinal de la Liga Contra el Cáncer seccional Risaralda, Pereira, Colombia. Se comparó el recuento ganglionar en especímenes quirúrgicos con y sin división ganglionar por regiones anatómicas previo a su envío a patología. Resultados. De los 94 pacientes intervenidos, 65 pertenecían al grupo A y 29 pacientes al grupo B. El promedio de ganglios fue de 24,4±8,6 y 32,4±14,4 respectivamente (p=0,004). El porcentaje de pacientes con más de 15 y de 25 ganglios fue menor en el grupo A que en el grupo B (27 vs 57, p=0,432 y 19 vs 24, p=0,014). El promedio de pacientes con una relación ganglionar menor 0,2 fue mayor en el grupo B (72,4 % vs 55,4 %, p=0,119). Conclusiones. Los resultados de nuestro estudio mostraron que una división por grupos ganglionares previo a la valoración del espécimen por el servicio de patología incrementa el recuento ganglionar y permite establecer de manera certera el pronóstico de los pacientes, teniendo un impacto positivo en su estadificación, para evitar el sobretratamiento
Introduction. A gastrectomy and lymph node dissection is the standard of management for patients with gastric cancer. Factors such as the identification of nodes by the pathologist can have a negative impact on staging and treatment. The objective of this study was to compare the lymph node count of a surgical specimen after a complete gastrectomy (group A) and of a specimen with lymph node by groups (group B). Methods. Study of a retrospective database of patients undergoing D2 gastrectomy in the Risaralda section of the Liga Contra el Cancer Gastrointestinal surgical service, Pereira, Colombia. The lymph node count was compared in surgical specimens with and without lymph node division by anatomical regions, prior to sending them to pathology. Results. Of the 94 patients who underwent surgery, 65 were from group A and 29 patients were from group B. The average number of nodes was 24.4±8.6 and 32.4±14.4, respectively (p=0.004). The percentage of patients with more than 15 and 25 nodes was lower in group A than in group B (27 vs 57, p=0.432 and 19 vs 24, p=0.014). The average number of patients with a nodal ratio less than 0.2 was higher in group B (72.4% vs 55.4%, p=0.119). Conclusions. The results of our study showed that a division by lymph node groups prior to the evaluation of the specimen by the pathology service increases the lymph node count and allows the prognosis of patients to be accurately established, having a positive impact on their staging, to avoid overtreatment.
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Humans , Stomach Neoplasms , Lymph Node Excision , Neoplasm Staging , Gastrectomy , Lymph Nodes , Lymphatic MetastasisABSTRACT
Objective:To investigate the value of LASSO regression prediction of lymph nodes around hepatic artery metastasis based on blood routine index in patients with distant gastric cancer.Methods:The clinical data of 110 patients with distant gastric cancer from June 2018 to February 2022 in Jieshou People′s Hospital were retrospective analyzed. Among them, 43 patients had lymph nodes around hepatic artery metastases (metastasis group), and 67 patients have not lymph nodes around hepatic artery metastases (non-metastasis group). The basic clinical data were recorded; the routine blood test was detected, the indexes including white blood cell count, neutrophil percentage, lymphocyte count, platelet count, lymphocyte percentage, acidophil count, basophils count, hemoglobin, red blood cell distribution width (RDW), platelet distribution width (PDW) and neutrophil to lymphocyte ratio (NLR). The R language 4.1.0 software "grpreg" package was used to establish a Group LASSO Logistic regression analysis model to finally select the factors predicting lymph node around hepatic arterial metastasis in patients with distal gastric cancer. Nomogram were made using R language 3.5.3 software package and rms program package, calculated the consistency index (C-index), and the accuracy of the model was evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.Results:The white blood cell count, neutrophil percentage, NLR and lymphocyte percentage in metastasis group were significantly higher than those in non-metastasis group: (12.16 ± 1.62) × 10 9/L vs. (9.38 ± 2.64) × 10 9/L, (73.36 ± 6.94)% vs. (52.21 ± 6.23)%, 3.23 ± 0.63 vs. 2.35 ± 0.13 and (48.62 ± 3.64)% vs. (31.02 ± 2.94)%, the acidophil count and basophils count were significantly lower than those in non-metastasis group: (0.31 ± 0.03) × 10 9/L vs. (0.36 ± 0.04) × 10 9/L and (0.08 ± 0.01) × 10 9/L vs. (0.09 ± 0.02) × 10 9/L, the degree of differentiation and TNM stage were also worse than those in non-metastasis group, and there were statistical differences ( P<0.01). The nomogram was constructed to predict lymph nodes around hepatic artery metastasis based on the degree of differentiation, TNM stage, white blood cell count, neutrophil percentage, NLR, lymphocyte percentage, acidophil count and basophils count in patients with distant gastric cancer, the scores of each indexes were 20.64, 26.42, 32.83, 25.78, 38.46, 35.65, 29.06 and 18.26 scores, the total score (227.10 scores) was the incidence of the nomogram model (29.82%). The validation result showed C-index of 0.819 and 0.806 (95% CI 0.785 to 0.864 and 0.779 to 0.816), and the correction curves for both sets were fitted well to the ideal curve with AUC of 0.801 and 0.810 (95% CI 0.784 to 0.826 and 0.795 to 0.852), and the decision curve showed high net benefit value with threshold probability from 1% to 9%. Conclusions:LASSO regression model combined with white blood cell count, neutrophil percentage, NLR, lymphocyte percentage, acidophil count and basophils count is ideal to predict lymph nodes around hepatic artery metastasis in patients with distant gastric cancer.
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Objective:To explore and analyze the correlation between thyroid peroxidase (TPO) and thyroglobulin (Tg) in patients with papillary thyroid carcinoma (papillary thyroid carcinoma, PTC) and to provide a more reasonable plan for the clinical diagnosis and treatment of patients.Methods:A retrospective analysis was made of 142 PTC patients who underwent surgical resection from Jun. 2019 to Jun. 2022 in the Oncology Department of Wenzhou Hospital of Traditional Chinese Medicine. 115 patients were selected, including 25 males (21.74%), and 90 females (78.26%), and the average age was (43.48±9.74) years old. The medical records, pathology reports, and demographic characteristics and pathological characteristics were collected. Immunohistochemical staining was used to detect the expression of TPO and Tg in PTC tissues, which were divided into positive and negative groups. Multifactorial Logistic regression analysis was used to analyze its relationship with clinicopathological characteristics and prognosis of patients.Results:The negative rate of TPO was 95.45% (105 cases). Univariate analysis showed that the tumor diameter ( t=5.746), lymph node metastasis, and the proportion of PT1 patients were significantly different between the two groups ( P<0.05), the TPO negative group was significantly higher than the positive group. Multivariate logistic regression analysis found that tumor diameter, lymph node metastasis, and proportion of PT1 patients were independent factors (95% CI=2.367-5.365, 1.101-2.738, 1.103-2.589, P<0.05). The positive rate of Tg was 77.41% (89 cases). Univariate analysis showed the proportion of people with BMI ≥ 25 ( χ2=11.180), tumor diameter ( t=2.117), and intracapsular invasion ( χ2=8.354), extrathyroidal invasion, lymph node metastasis ( χ2=27.740), and proportion of PT1 patients were significantly different between the two groups ( P<0.05). Multivariate logistic regression analysis found BMI≥25, intracapsular invasion, extrathyroidal invasion, lymph node metastasis, proportion of PT1 patients were independent factors affecting Tg in patients with PTC (95% CI=3.845-11.735, 1.485-2.983,1.171-2.762,4.083-16.526,1.003-2.174, P<0.05). There was a negative correlation between the expression of TPO and Tg in PTC ( r=-0.498, P<0.001) . Conclusion:TPO and Tg are highly correlated with tumor lymphatic metastasis, pathological grade, tumor diameter and tumor invasion range in patients with papillary thyroid carcinoma, and the expression of the two is negatively correlated, which can be used as effective indicators for evaluating the prognosis of patients.
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Lateral drainage is an important way for the middle and lower rectum. There are still disputes between Eastern and Western scholars regarding the treatment strategy of lateral lymph node metastasis. It is difficult to diagnose lateral lymph node metastasis by pathologic examination before surgery. MRI is the main method for diagnosis of lateral lymph node metastasis in rectal cancer. The diagnostic criteria for patients before and after neoadjuvant treatment are slightly different. CT, PET/CT and radiomics also have certain advantages in the diagnosis of lateral lymph node metastasis. If necessary, the combination of multiple methods can help in the diagnosis of lateral lymph node metastasis.
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Objective:To investigate the effect of lymph node metastasis on the prognosis of patients with G2 phase stage pancreatic neuroendocrine neoplasm(pNEN).Methods:A retrospective case control study was conducted to analyze the case data of 368 patients with pancreatic neuroendocrine tumors in G2 phase stage from January 1, 2010 to December 31, 2016 in SEER database, including 174 males and 194 females. According to whether lymph nodes were metastatic, they are divided into lymph node non metastatic (N0) group ( n=272) and lymph node metastatic (N1) group ( n=96). The Kaplan-Meier method and Log-rank test were used to compare the overall survival rate (OS) of patients in the N0 and N1 groups. The COX proportional risk model was used to evaluate whether N stage was an independent risk factor affecting prognosis. Count data were expressed as cases and percentage(%), and Chi-square test was used for comparison between the groups. Results:Among all patients, the OS of patients in the N0 group was better than that of patients in the N1 group. The OS of N0 patients at 1, 3, and 5 years was 96.3%, 92.7%, and 85.6%, respectively, while the OS of N1 patients at 1, 3, and 5 years was 92.6%, 82.1%, and 82.1%, respectively ( P=0.014). Multivariate analysis showed that age ( HR=2.245, 95% CI: 1.126-4.475, P=0.022) and N stage ( HR=0.457, 95% CI: 0.237-0.883, P=0.020) were independent prognostic factors for G2 phase pNEN patients. Conclusion:Lymph node metastasis is one of the independent prognostic factors in patients with G2 phase stage pNEN.
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Abstract Objectives Oral tongue cancer is the most prevalent type of oral cavity cancer and presents the worst prognosis. With the use of TNM staging system, only the size of primary tumor and lymph node are considered. However, several studies have considered the primary tumor volume as a possible significant prognostic factor. Our study, therefore, aimed to explore the role of nodal volume from imaging as a prognostic implication. Methods Medical records and imaging (either from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan) of 70 patients diagnosed with oral tongue cancer with cervical lymph node metastasis between January 2011 and December 2016 were retrospectively reviewed. The pathological lymph node was identified, and nodal volume was measured using the Eclipse radiotherapy planning system and was further analysed for its prognostic implications, particularly on overall survival, disease-free survival, and distant metastasis-free survival. Results From A Receiver Operating Characteristic (ROC) curve analysis, the optimal cut-off value of the nodal volume was 3.95 cm3, to predict the disease prognosis, in terms of overall survival and metastatic-free survival (p≤ 0.001 and p= 0.005, respectively), but not the disease-free survival (p= 0.241). For the multivariable analysis, the nodal volume, but not TNM staging, was a significant prognostic factor for distant metastasis. Conclusions In patients with oral tongue cancer and cervical lymph node metastasis, the presence of an imaging nodal volume of ≥3.95 cm3 was a poor prognostic factor for distant metastasis. Therefore, the lymph node volume may have a potential role to adjunct with the current staging system to predict the disease prognosis. Level of Evidence: 2b.
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Abstract Background The presence of Extracapsular Extension (ECE) in the Sentinel Lymph Node Biopsy (SLNB) is still a doubt in the literature. Some studies suggest that the presence of ECE may be related to a greater number of positive axillary lymph nodes which could impact Disease Free Survival (DFS) and Overall Survival (OS). This study searches for the clinical significance of the ECE. Methods Retrospective cohort comparing the presence or absence of ECE in T1-2 invasive breast cancer with positive SLNB. All cases treated surgically at the Cancer Institute of the State of São Paulo (ICESP) between 2009 and 2013 were analyzed. All patients with axillary disease in SLNB underwent AD. Outcomes Identify the association between the presence and length of ECE and additional axillary positive lymph nodes, OS and DFS between both groups. Results 128 patients with positive SLNB were included, and 65 had ECE. The mean metastasis size of 0.62 (SD = 0.59) mm at SLNB was related to the presence of ECE (p < 0.008). The presence of ECE was related to a higher mean of positive sentinel lymph nodes, 3.9 (± 4.8) vs. 2.0 (± 2.1), p = 0.001. The median length of follow-up was 115 months. The OS and DFS rates had no differences between the groups. Conclusion The presence of ECE was associated with additional positive axillary lymph nodes in this study. Therefore, the OS and DFS were similar in both groups after 10 years of follow-up. It is necessary for additional studies to define the importance of AD when SLNB with ECE.
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SUMMARY OBJECTIVE: Tumor-to-skin distance is known to have an effect on axillary lymph node metastasis but has no clinical use with nomograms. This study aimed to investigate the effect of tumor-to-skin distance on axillary lymph node metastasis alone and in combination with nomogram for clinical use. METHODS: A total of 145 patients who underwent surgery for breast cancer (T1-T2 stage) and whose axillary lymph nodes were evaluated (axillary dissection or sentinel lymph node biopsy) between January 2010 and December 2020 were included in the study. Tumor-to-skin distance and other pathological data of the patients were evaluated. RESULTS: Of the 145 patients, 83 (57.2%) had metastatic lymph nodes in the axilla. Tumor-to-skin distance was different in terms of lymph node metastasis (p=0.045). In the receiver operating characteristic curve for tumor-to-skin distance, area under curve was 0.597 (95%CI 0.513-0.678, p=0.046), area under curve of the nomogram was 0.740 (95%CI 0.660-0.809), p<0.001) and nomogram+tumor-to-skin distance was 0.753 (95%CI 0.674-0.820), p<0.001). No statistical difference was found for axillary lymph node metastasis between the nomogram+tumor-to-skin distance and the nomogram alone (p=0.433). CONCLUSION: Although tumor-to-skin distance demonstrated a significant difference in axillary lymph node metastasis, it had a poor association with an area under curve value of 0.597 and did not produce a significant improvement in predicting lymph node metastasis when combined with the nomogram. The tumor-to-skin distance may be unlikely to enter clinical practice.
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@#The lymphatic system is the main way of tumor metastasis and diffusion. Esophageal cancer is one of the typical cancers that are prone to metastasis through the lymphatic system. At present, an increasing number of studies show that the interaction between tumor cells and lymphatic endothelial cells is the first step in tumor lymphatic metastasis, but the underlying molecular mechanism is unclear. This article reviews the role and changes of tumor-related lymphatic vessels and lymphatic endothelial cells in the process of tumor lymphatic metastasis, which lays a foundation for further study of the specific molecular mechanism of esophageal cancer lymphatic metastasis and provides a new treatment direction for esophageal cancer patients.
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Objective:To investigate the efficacy and adverse reactions of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) combined with chemotherapy in the treatment of superior mediastinal lymph node metastasis after esophageal cancer surgery.Methods:The clinical data of 72 patients with concurrent chemoradiotherapy for superior mediastinal lymph node metastasis after esophageal cancer surgery in Tai'an Cancer Prevention and Treatment Hospital from January 2019 to May 2021 were retrospectively analyzed, and they were divided into intensity-modulated radiotherapy (IMRT) group (36 cases) and SIB-IMRT group (36 cases) according to different radiotherapy methods. The short-term efficacy, long-term survival rate and adverse reactions of the two groups were compared.Results:The response rate in the IMRT group was 66.7% (24/36), the response rate in the SIB-IMRT group was 86.1% (31/36), and the difference between the two groups was statistically significant ( χ2 = 3.77, P = 0.047). The 1-, 2- and 3-year overall survival rates in the IMRT group were 75.0%, 44.4% and 27.8%, and the 1-, 2- and 3-year overall survival rates in the SIB-IMRT group were 83.3%, 52.8% and 33.3%; the difference in the overall survival between the two groups was not statistically significant ( χ2 = 0.70, P = 0.401). There were statistical differences in the incidence of leukopenia, radiation esophagitis and radiation pleural gastritis between the two groups (all P < 0.05). There were no statistical differences in the incidence of radiation pneumonia and gastrointestinal reactions between the two groups (both P > 0.05). Conclusions:SIB-IMRT combined with chemotherapy in patients with superior mediastinal lymph node metastasis after esophageal cancer surgery has good local control rate and mild adverse reactions.
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Objective:To investigate whether radiomics based on ultrasound images can predict lym-phatic metastasis of rectal cancer before surgery.Methods:A total of 80 patients with rectal cancer who underwent endorectal ultrasound (TRUS) and endorectal elastography were confirmed by postoperative pathology in Zhejiang Cancer Hospital from January 2016 to December 2019 were retrospectively analyzed. The general characteristics (gender, age, tumor size, depth of tumor infiltration, tumor location, carcinoembryonic antigen, glycoantigen 199) of the lymph node metastasis group ( n=27) and the non-metastasis group ( n=53) were compared, and the clinical risk factors with statistically significant differences were screened out. The tumor maximum sagittal 2D TRUS images and endorectal elastography were manually outlined, and the radiomics features were extracted using the open source software pyradiomics 3.0.1, and the filtering and embedding methods were used to reduce the dimensionality of the data to select the important features and obtain the best parameters of the model. Then all samples were randomly divided into training and validation sets in the ratio of 8∶2, the models were trained using the best model parameters, which were tested and validated in the validation set, and the predictive efficacy of different models was evaluated according to the ROC curve. Results:The depth of tumor infiltration was statistically significant in predicting whether the lymph nodes metastasized or not (χ 2=11.555, P<0.05), and its area under ROC curve(AUC) value was 0.699. A total of 1 710 features were extracted from sagittal 2D TRUS images and endorectal elastography. After pre-processing and screening, 10 features were strongly correlated with lymph node metastasis status. The 10 features were used to construct the prediction models with AUC values of 0.703, 0.726 and 0.742 for the Logistic Regression Model, Random Forest Model and Support Vector Machine Model, respectively. And the AUC value of the ensemble averaging model in the validation set was 0.734. The imaging-omics prediction model outperformed the prediction model based on statistical analysis of clinical data (AUC: 0.734 vs 0.699, Z=1.984), with a statistically significant difference ( P<0.05). Conclusions:The endorectal ultrasound and endorectal elastography-based radiomics model constructed in this study is better than the model constructed based on statistical analysis of clinical data only, and it is valuable for preoperative lymph node metastasis prediction in rectal cancer.
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Objective:To investigate the value of preoperative enhanced CT combined with serum cytokeratin fragment 19 (CYFER21-1) and neuron-specific enolase (NSE) in the diagnosis of lymph node metastasis in patients with non-small cell lung cancer (NSCLC).Methods:160 patients with NSCLC admitted to Linyi Cancer Hospital from October 2018 to October 2021 were retrospectively selected. All patients received surgical treatment in our hospital, and 84 patients with lymph node metastasis (metastatic group) and 76 patients without lymph node metastasis (non-metastatic group) were confirmed after surgery. The features of enhanced CT images and serum CYFER21-1 and NSE levels were compared between the two groups before operation, and the value of each index in the diagnosis of lymph node metastasis in patients with NSCLC alone and in combination was analyzed by receiver operating characteristic (ROC) curve.Results:The proportions of patients with lesion diameter ≥3.0 cm, pleural depression, lymph node enlargement shown by CT, lymph node short diameter ≥10 mm, lymph node boundary ambiguity and lymph node enhancement in metastatic group were significantly higher than those in non-metastatic group, with statistical significance (all P<0.05). Serum CYFER21-1 and NSE levels in metastatic group were significantly higher than those in non-metastatic group, with statistical significance (all P<0.05). The area under curve (AUC) of CYFER21-1 and NSE levels in the diagnosis of lymph node metastasis in NSCLC patients were 0.652 and 0.845, respectively, and the diagnostic cut-off values were 4.81 ng/ml and 24.14 ng/ml, respectively. The sensitivity and specificity of CYFER21-1+ NSE+ enhanced CT in the diagnosis of lymph node metastasis in NSCLC patients were 91.67% and 94.74%. Conclusions:Preoperative enhanced CT is of certain clinical value in the diagnosis of lymph node metastasis in NSCLC patients. Combined with serum CYFER21-1 and NSE levels, enhanced CT can further improve the sensitivity and specificity of diagnosis.
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Objective:To explore the clinical value of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of thyroid cancer and assessment of cervical lymph node metastasis.Methods:The clinical data of 90 patients with thyroid cancer who received treatment in Zhoushan Hospital from October 2018 to April 2021 were retrospectively analyzed. All patients underwent a two-dimensional ultrasound examination and ultrasound-guided fine-needle aspiration biopsy before surgery. Taking surgical and pathological diagnosis as the gold standard, the efficiency of two-dimensional ultrasound examination versus ultrasound-guided fine-needle aspiration biopsy in the diagnosis of thyroid cancer and cervical lymph node metastasis and in the identification of benign and maligant lymph nodes were investigated. Multivariate Logistic regression analysis was performed to analyze the correlation between different ultrasound signs and the detection rate of lymph nodes. Results:Pathological results showed that among the 90 patients, 73 patients had thyroid cancer, and 17 patients had benign lesions. Ultrasound-guided fine-needle aspiration biopsy results showed that 70 patients had thyroid cancer, and 20 patients had benign lesions, including 4 cases of missed diagnosis and 2 cases of misdiagnosis. The diagnostic sensitivity, specificity, accuracy rate, and Kappa value were 94.52%, 88.24%, 93.33%, and 0.79, respectively. These were highly consistent with the surgical and pathological diagnosis (Kappa value > 0.75). Two-dimensional ultrasound revealed 69 patients with thyroid cancer and 21 patients with benign lesions, including 7 cases of missed diagnosis and 4 cases of misdiagnosis. The diagnostic sensitivity, specificity, accuracy rate, and Kappa value were 90.41%, 76.47%, 87.78%, and 0.63, respectively. Pathological results revealed that cervical lymph node metastasis occurred in 12 patients, and it did not occur in 78 patients. The diagnostic sensitivity, specificity, accuracy rate, and Kappa value of ultrasound-guided fine-needle aspiration biopsy were 83.33%, 97.50%, 95.65%, and 0.81 respectively. These were highly consistent with surgical and pathological results (Kappa value > 0.75). The diagnostic sensitivity, specificity, accuracy rate, and Kappa value of two-dimensional ultrasound examination were 75.00%, 94.87%, 92.22%, and 0.67, respectively. A total of 156 lymph nodes were detected by ultrasound-guided fine-needle aspiration biopsy, including 103 benign lymph nodes and 53 malignant lymph nodes, with a diagnostic accuracy rate of 94.17% and 96.22%, respectively. A total of 173 lymph nodes were detected by two-dimensional ultrasound, including 111 benign lymph nodes and 62 malignant lymph nodes, with a diagnostic accuracy rate of 91.89% and 91.93%, respectively. There were no significant differences in the diagnostic accuracy of benign and malignant lymph nodes between the two examination methods ( χ2 = 0.42, 0.92, both P > 0.05). Multivariate logistic regression analysis showed that hyperechoic masses, cystic lesions, and internal calcification were significantly correlated with the detection rate of lymph nodes diagnosed by two-dimensional ultrasound and ultrasound-guided fine-needle aspiration biopsy ( OR = 6.64, 5.32, 4.12, 7.07, 5.60, 5.06, all P < 0.05). Conclusion:Ultrasound-guided fine-needle aspiration biopsy has high diagnostic efficiency for thyroid cancer and cervical lymph node metastasis. Ultrasound signs of hyperechoic mass, cystic lesions, and internal calcification are significantly correlated with the detection rate of lymph nodes.
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Objective:To investigate the changes in serum miRNA-21 and miRNA-4534 levels in patients with lung adenocarcinoma and their relationships with pathological characteristics and prognosis.Methods:A total of 148 patients with lung adenocarcinoma who received treatment in the First People's Hospital of Huzhou from January 2018 to January 2019 were included in the observation group. An additional 100 healthy controls who concurrently received physical examinations were included in the control group. The relative expression of serum miRNA-21 and miRNA-4534 was measured using real-time fluorescence quantitative PCR. The relative expression of serum miRNA-21 and miRNA-4534 was compared between the two groups. The relative expression of serum miRNA-21 and miRNA-4534 was compared between patients with different pathological characteristics. Total survival time was compared between patients with high and low miRAN-21 expression and between patients with high and low miRNA-4534 expression.Results:The relative expression of miRNA-21 and miRNA-4534 in the observation group was 3.27 ± 0.87 and 6.74 ± 1.56, respectively, which was significantly higher than 1.00 ± 0.01 and 1.02 ± 0.02 in the control group ( t = 20.07, 36.64, both P < 0.05). There was no significant difference in the relative expression of miRNA-21 and miRNA-4534 between different genders, ages, body mass index values, tumor regions, and tumor diameters (all P > 0.05). The relative expression of serum miRNA-21 in patients with stage Ⅲ-Ⅳ lung adenocarcinoma was 4.45 ± 1.05, which was significantly higher than 1.92 ± 0.53 in patients with stage Ⅰ-Ⅱ lung adenocarcinoma. The relative expression of serum miRNA-21 in patients with lymph node metastasis was higher than that in patients without lymph node metastasis (4.97 ± 1.28 vs. 1.34 ± 0.60, t = 17.53, 23.48, both P < 0.05). The relative expression of miRNA-4534 in patients with stage Ⅲ-Ⅳ lung adenocarcinoma was higher than that in patients with stage Ⅰ-Ⅱ lung adenocarcinoma (8.97 ± 1.85 vs. 4.48 ± 1.09, t = 17.17, P < 0.05). The relative expression of miRNA-4534 in patients with lymph node metastasis was higher than that in patients without lymph node metastasis (9.65 ± 1.35 vs. 3.78 ± 0.91, t = 30.59, P < 0.05). The total survival time in patients with high miRNA-21 expression was shorter than that in patients with low miRNA-21 expression [(18.37 ± 4.35) months vs. (29.93 ± 3.24) months, t = 18.45, P < 0.05]. The total survival time in patients with high miRNA-4534 expression was shorter than that in patients with low miRNA-4534 expression [(17.56 ± 4.21) months vs. (30.43 ± 3.63) months, t = 19.97, P < 0.05)]. Conclusion:Patients with lung adenocarcinoma have high expression of miRNA-21 and miRNA-4534 in the serum, which is closely related to the tumor-node-metastasis stage, lymph node metastasis, and prognosis.
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BACKGROUND: The measurement of plasma thyroglobulin (Tg) is widely used in the monitoring of differentiated thyroid cancer (CDT). In recent years, its value as a prognostic marker prior to ablation with radioiodine has increased, demonstrating its high negative predictive value. Recent studies indicate that a wide variety of factors could potentially influence pre-ablative Tg values, including residual tumor burden and stimulation modality. Aim: To relate the value of pre-ablative Tg with the amount of preoperative disease burden, lymph node metastases, treatment, and presence of residual disease. MATERIAL AND METHODS: Retrospective observational study of 70 patients with CDT treated between 2012 and 2018. The amount of disease burden was defined as the sum of largest diameter of individual tumors in each patient, and as the individually largest tumor per patient and number of metastatic lymph nodes. RESULTS: A smaller tumor size and absence of remnant tissue was associated with lower Tg values, although the association was not always significant. Furthermore, no significant difference was found between Tg levels measured within or more than 14 days after the surgical procedure. Thus, an early measurement of pTg after surgery would allow an initial therapeutic decision making. Conclusions: A statistical association between pre-ablative Tg levels and the amount of preoperative tumor tissue burden was found in some subgroups of patients.
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Humans , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Adenocarcinoma , Thyroglobulin/analysis , Thyroidectomy , Retrospective Studies , Iodine Radioisotopes , Lymphatic MetastasisABSTRACT
ABSTRACT Purpose: To determine independent predictors of inguinal lymph node (ILN) metastasis in patients with penile cancer. Patients and methods: We retrospectively analyzed all patients with penile cancer who underwent surgery at our medical center in the last ten years (n=157). Using univariate and multivariate logistic-regression models, we assessed associations with age, medical-history, phimosis, onset-time, number and maximum diameter of involved ILNs measured by imaging, pathological T stage, degree of tumor differentiation and/or cornification, lymphatic vascular infiltration (LVI), nerve infiltration, and ILN metastases. Interaction and stratified analyses were used to assess age, phimosis, onset time, number of ILNs, cornification, and nerve infiltration. Results: A total of 110 patients were included in the study. Multiple logistic regression analysis showed that the following factors were significantly correlated with ILN metastasis: maximum diameter of enlarged ILNs, T stage, pathological differentiation, and LVI. Among patients with a maximum ILN diameter ≥1.5cm, 50% had lymph node metastasis whereas 30.6% patients with a maximum ILN diameter <1.5cm showed LNM. Among 44 patients with stage Ta/T1, 10 showed ILN metastases, while 47.0% patients with stage T2 showed ILN metastases. Among 40 patients with highly differentiated penile-cancer, eight showed ILN metastasis, while 47.1% patients with low-to-middle differentiation showed ILN metastases. The rate of LNM was 33.3% in the LVI-free group and 64.3% in the LVI group. Conclusion: Our single-center results suggested that maximum ILN diameter, pathological T stage, pathological differentiation, and LVI were independent risk factors for ILN metastases.
Subject(s)
Humans , Male , Penile Neoplasms/surgery , Penile Neoplasms/pathology , Prognosis , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Lymph Node Excision , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Neoplasm StagingABSTRACT
Objective:To analyze the efficacy of quantitative parameters related to spectral CT iodine concentration (IC) values in evaluating regional lymph node metastasis in patients with gastric adenocarcinoma.Methods:The clinical data and CT images of 55 patients with gastric adenocarcinoma diagnosed by pathology from June 2021 to June 2022 were collected retrospectively at Shengjing Hospital of China Medical University. Patients were divided into lymph node metastatic lesion group (32 cases) and lymph node non-metastatic lesion group (23 cases) according to whether there were metastatic lymph nodes in all the lymph nodes examined in the pathological results. Then lymph nodes were taken as the research object, and all lymph nodes were divided into the metastatic lymph node group (25 lymph nodes) and the non-metastatic lymph node group (27 lymph nodes) according to the nature of lymph nodes recorded in the pathological report. The IC values and normalized IC (nIC) values of gastric cancer lesions and lymph nodes in the arterial and venous phases (ICa and ICp, nICa and nICp) were obtained. The difference of IC and nIC values between arterial and venous phases (?IC and ?nIC) were calculated, and the arterial enhancement fraction (AEF, ratio of ICa and ICp of lymph nodes ) was calculated. Student′s t test or Mann-Whitney U test was used to compare the differences of quantitative parameters between the two groups. The parameters with statistical differences were analyzed by the receiver operating characteristic curve to obtain the diagnostic efficacy of each parameter in evaluating lymph node metastasis of gastric cancer, and the Z test was used to compare the area under the curve (AUC) of each parameter. Results:The ICp, nICp, ?IC and ?nIC of the lymph node metastatic lesion group were higher than those of the lymph node non-metastatic lesion group (all P<0.05). The AUC were 0.738, 0.746, 0.811 and 0.821. The short diameter, ICa, nICa and AEF values of lymph nodes in the metastatic lymph node group were higher than those in the non-metastatic lymph node group (all P<0.05). The AUC were 0.821, 0.832, 0.734 and 0.863. There were significant differences in AUC between ICp and ?IC, ?nIC ( Z=2.41, 3.29, P=0.016, 0.001), and between nICp and ?IC, ?nIC ( Z=2.10, 3.09, P=0.036, 0.002) in gastric cancer lesions. There were statistically significant differences in AUC between nICa and ICa, AEF ( Z=2.09, 2.41, P=0.037, 0.016) in lymph nodes. Conclusions:The quantitative parameters related to IC values of spectral CT can be applied to evaluate the properties of regional lymph nodes in patients with gastric adenocarcinoma, where ?IC, ?nIC of lesions and AEF of lymph nodes have the best efficacy.
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Objective:To investigate the clinical value of imaging features of primary lesions combined with venous phase CT value in predicting central group lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC) .Methods:Clinical data of 170 PTC patients who underwent central group LN dissection in the First People's Hospital of Handan City of Hebei Province from January 2017 to June 2020 were retrospectively analyzed. All patients were divided into different groups according to whether central group LN metastasis or not, and there were 89 patients with central group LN metastasis and 81 patients without central group LN metastasis. The CT value and imaging features of primary lesions in different periods were analyzed, and the imaging features of primary lesions combined with venous phase CT values to predict the central group LN metastasis were evaluated by the receiver operating characteristic (ROC) curve.Results:There were no statistically significant differences in CT value in plain scan phase and CT value, net increased CT value, standardized CT value in arterial phase between patients with and without central group LN metastasis (all P>0.05) . The CT value, net increased CT value and standardized CT value in venous phase of patients with central group LN metastasis were (113.84±22.95) HU, (59.05±12.10) HU and 0.72±0.14 respectively, which were significantly higher than those of patients without central group LN metastasis [ (103.99±17.67) HU, (51.29±14.45) HU and 0.59±0.10] ( t=3.26, P<0.001; t=3.81, P<0.001; t=3.67, P<0.001) . ROC curve analysis showed that the area under the curve for diagnosing central group LN metastasis of PTC patients was 0.75, 0.70 and 0.76 when the cut-off values of CT value, net increased CT value and standardized CT value in venous phase were 115.78 HU, 62.37 HU and 0.75 respectively. There were statistically significant differences in the diameter of primary focus and the contact area of thyroid capsule between patients with and without central group LN metastasis ( Z=-2.34, P=0.019; Z=-2.08, P=0.037) . There were no statistically significant differences between calcification and primary lesion location (both P>0.05) . Lesion diameter >2 cm (87.73%) and capsule contact range ≥1/2 (92.17%) had the highest specificity in predicting central group LN metastasis. The imaging features of primary lesion combined with standardized CT value in venous phase was in good agreement with histopathological diagnosis results in predicting central group LN metastasis (Kappa=0.475) , and the sensitivity and specificity were 73.12% and 82.75% respectively. Conclusion:The imaging features of the primary lesion combined with CT value in venous phase have a good clinical value in predicting central group LN metastasis in PTC patients. Patients with primary lesion diameter >2 cm, capsule contact range ≥1/2 and the standardized CT value in venous phase >0.75 are more likely to have central group LN metastasis.
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Objective:To analyze the characteristics and influencing factors of the patients with cervical lymph node skip metastasis of papillary thyroid carcinoma (PTC), as to guide the precise treatment of lateral area.Methods:The clinicopathological data of 237 patients with PTC initially diagnosed and treated in Xuanwu Hospital Capital Medical University from Feb 2014 to Mar 2022 were analyzed retrospectively. Among them, there were 217 positive in the central area, and 20 negative, with skip rate 8.4%. The age, sex, pathological type, glandular lobe involvement, tumor size, number of tumor lesions, primary lesion location, and capsule invasion were statistically compared. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the t test. The measurement data of non normal distribution are expressed by M( Q1, Q3), and the Mann Whitney U test is used for comparison between groups. Comparison between groups of count data was conducted using the chi-square test, correction chi-square or Fisher exact probability. Results:Multivariate analysis showed that age ≥ 55 years old( OR: 6.032, 95% CI: 1.692-21.504, P=0.006), female( OR: 23.459, 95% CI: 2.181-252.341, P=0.009), tumor ≤5 mm( OR: 79.453, 95% CI: 7.570-833.891, P<0.001)and located in the upper lobe( OR: 3.446, 95% CI: 1.325-8.962, P=0.011) were independent risk factors for skip metastasis. The patients with skip metastasis had a smaller total number of cervical lymph node metastases( Z=-2.81, P=0.005), smaller total number of neck dissection lymph nodes( Z=-6.62, P<0.001) and less lymph nodes metastases in level Ⅳ( Z=-2.54, P=0.011) than patients with non-skip metastasis. Conclusions:Skip metastasis often occurred with age ≥55 years, female, tumor size less than 5mm and located in the upper lobe. For these patients, careful evaluation for the lateral area is required.
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Objective:To investigate the application of ultrasound thyroid imaging report and data system (TI-RADS) score, serum galectin-3, microRNA (miR) -599 in cervical lymph node metastasis of papillary thyroid carcinoma (PTC).Methods:A total of 98 patients with PTC admitted to China Resources Medical Huaibei Miners General Hospital from March 2019 to March 2021 were selected and divided into the metastasis group (48 cases) and the non-metastasis group (50 cases) according to the state of cervical lymph node metastasis dignosedby the pathological examination. The baseline data, ultrasound TI-RADS score, serum galectin-3, miR-599 were compared between the two groups. Multivariate Logistic regression analysis was used to analyze the related factors of cervical lymph node metastasis, receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to analyze the value ofpredicting cervical lymph node metastasis.Results:The ultrasound TI-RADS scores and galectin-3 level in the metastasis group were higher than those in the non-metastasis group: (11.72 ± 2.85) scores vs. (8.15 ± 2.60) scores, (5.54 ± 1.76) μg/L vs. (4.02 ± 1.27) μg/L, the miR-599 level in the metastasis group was lower than that in the non-metastasis group: 0.25 ± 0.08 vs. 0.36 ± 0.10, there were statistical differences ( P<0.05). The results of multivariate Logistic regression analysis showed that the ultrasound TI-RADS score, serum galectin-3 and miR-599 were still associated with cervical lymph node metastasis in PTC patients after controlling the clinical stage ( P<0.05). The results of ROC curve analysis showed that the AUC for ultrasound TI-RADS score, serum galectin-3 combined with miR-599 in evaluating cervical lymph node metastasis was the largest (0.889). The metastasis rate of patients with high levels of ultrasound TI-RADS and serum galectin-3 were higher than those with low levels, and the metastasis rate of patients with high level of miR-599 was lower than that of patients with low level , there were statistical differences ( P<0.05). Conclusions:Ultrasound TI-RADS score, serumgalectin-3, miR-599 are related to cervical lymph node metastasis in PTC patients, and combined detection is expected to become a scheme for evaluating cervical lymph node metastasis.