Lymphatic metastasis(LM)emerges as an independent prognostic marker for hypopharyngeal squamous cell carcinoma(HSPSCC),chiefly contributing to treatment inefficacy.This study aimed to scrutinize the prognostic relevan...Lymphatic metastasis(LM)emerges as an independent prognostic marker for hypopharyngeal squamous cell carcinoma(HSPSCC),chiefly contributing to treatment inefficacy.This study aimed to scrutinize the prognostic relevance of HSP90AA1 and its potential regulatory mechanism of concerning LM in HPSCC.Methods:In a preceding investigation,HSP90AA1,a differential gene,was discovered through transcriptome sequencing of HPSCC tissues,considering both the presence and absence of LM.Validation of HSP90AA1 expression was accomplished via qRT-PCR,western-blotting(WB),and immunohistochemistry(IHC),while its prognostic significance was assessed employing Kaplan–Meier survival analysis(KMSA),log-rank test(LR),and Cox’s regression analysis(CRA).Bioinformatics techniques facilitated the prediction and analysis of its plausible mechanisms in LM,further substantiated by in vitro and in vivo experiments utilizing FaDu cell lines.Results:HSP90AA1 is substantially upregulated in HPSCC with LM and is identified as an independent prognostic risk determinant.The down-regulation of HSP90AA1 can achieve inhibition of tumor cell proliferation,migration and invasion.Both in vivo experiments and Bioinformatics exploration hint at promoting LM by Epithelial-mesenchymal transition(EMT),regulated by HSP90AA1.Conclusions:HSP90AA1,by controlling EMT,can foster LM in HPSCC.This finding sets the foundation for delving into new therapeutic targets for HPSCC.展开更多
Background:Lymphatic metastasis has been associated with poor prognosis in bladder cancer patients with limited therapeutic options.Emerging evidence shows that heat shock factor 1(HSF1)drives diversified transcriptom...Background:Lymphatic metastasis has been associated with poor prognosis in bladder cancer patients with limited therapeutic options.Emerging evidence shows that heat shock factor 1(HSF1)drives diversified transcriptome to promote tumor growth and serves as a promising therapeutic target.However,the roles of HSF1 in lymphatic metastasis remain largely unknown.Herein,we aimed to illustrate the clinical roles and mechanisms of HSF1 in the lymphatic metastasis of bladder cancer and explore its therapeutic potential.Methods:We screened the most relevant gene to lymphatic metastasis among overexpressed heat shock factors(HSFs)and heat shock proteins(HSPs),and analyzed its clinical relevance in three cohorts.Functional in vitro and in vivo assays were performed in HSF1-silenced and-regained models.We also used Coimmunoprecipitation to identify the binding proteins of HSF1 and chromatin immunoprecipitation and dual-luciferase reporter assays to investigate the transcriptional program directed by HSF1.The pharmacological inhibitor of HSF1,KRIBB11,was evaluated in popliteal lymph node metastasis models and patientderived xenograft models of bladder cancer.Results:HSF1 expression was positively associated with lymphatic metastasis status,tumor stage,advanced grade,and poor prognosis of bladder cancer.Importantly,HSF1 enhanced the epithelial-mesenchymal transition(EMT)of cancer cells in primary tumor to initiate metastasis,proliferation of cancer cells in lymph nodes,and macrophages infiltration to facilitate multistep lymphatic metastasis.Mechanistically,HSF1 interacted with protein arginine methyltransferase 5(PRMT5)and jointly induced the monomethylation of histone H3 at arginine 2(H3R2me1)and symmetric dimethylation of histone H3 at arginine 2(H3R2me2s).This recruited the WD repeat domain 5(WDR5)/mixed-lineage leukemia(MLL)complex to increase the trimethylation of histone H3 at lysine 4(H3K4me3);resulting in upregulation of lymphoid enhancer-binding factor 1(LEF1),matrix metallopeptidase 9(MMP9),C-C motif chemokine ligand 20(CCL20),and E2F transcription factor 2(E2F2).Application of KRIBB11 significantly inhibited the lymphatic metastasis of bladder cancer with no significant toxicity.Conclusion:Our findings reveal a novel transcriptional program directed by the HSF1-PRMT5-WDR5 axis during the multistep process of lymphatic metastasis in bladder cancer.Targeting HSF1 could be a multipotent and promising therapeutic strategy for bladder cancer patients with lymphatic metastasis.展开更多
BACKGROUND Upper gastrointestinal neoplasia mainly includes esophageal cancer and gastric cancer,both of which have high morbidity and mortality.Lymph node metastasis(LNM),as the most common metastasis mode of both di...BACKGROUND Upper gastrointestinal neoplasia mainly includes esophageal cancer and gastric cancer,both of which have high morbidity and mortality.Lymph node metastasis(LNM),as the most common metastasis mode of both diseases,is an important factor affecting tumor stage,treatment strategy and clinical prognosis.As a new fusion technology,endoscopic ultrasound(EUS)is becoming increasingly used in the diagnosis and treatment of digestive system diseases,but its use in detecting LNM in clinical practice remains limited.AIM To evaluate the diagnostic value of conventional EUS for LNM in upper gastrointestinal neoplasia.METHODS Using the search mode of“MeSH+Entry Terms”and according to the predetermined inclusion and exclusion criteria,we conducted a comprehensive search and screening of the PubMed,EMBASE and Cochrane Library databases from January 1,2000 to October 1,2022.Study data were extracted according to the predetermined data extraction form.The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool,and the results of the quality assessment were presented using Review Manager 5.3.5 software.Finally,Stata14.0 software was used for a series of statistical analyses.RESULTS A total of 22 studies were included in our study,including 2986 patients.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic score and diagnostic odds ratio of conventional EUS in the diagnosis of upper gastrointestinal neoplasia LNM were 0.62[95%confidence interval(CI):0.50-0.73],0.80(95%CI:0.73-0.86),3.15(95%CI:2.46-4.03),0.47(95%CI:0.36-0.61),1.90(95%CI:1.51-2.29)and 6.67(95%CI:4.52-9.84),respectively.The area under the summary receiver operating characteristic curve was 0.80(95%CI:0.76-0.83).Sensitivity analysis indicated that the results of the meta-analysis were stable.There was considerable heterogeneity among the included studies,and the threshold effect was an important source of heterogeneity.Univariable meta-regression and subgroup analysis showed that tumor type,sample size and EUS diagnostic criteria were significant sources of heterogeneity in specificity(P<0.05).No significant publication bias was found.CONCLUSION Conventional EUS has certain clinical value and can assist in the detection of LNM in upper gastrointestinal neoplasia,but it cannot be used as a confirmatory or exclusionary test.展开更多
Prostate cancer(PCa)is one of the most frequent cancers in men,and its biomolecular targets have been extensively studied.This study aimed to analyze the expression of toll-like receptor 9(TLR9)and vascular endothelia...Prostate cancer(PCa)is one of the most frequent cancers in men,and its biomolecular targets have been extensively studied.This study aimed to analyze the expression of toll-like receptor 9(TLR9)and vascular endothelial growth factor C(VEGF-C)and the clinical value of the coexpression of TLR9 and VEGF-C in PCa.We retrospectively evaluated 55 patients with clinically localized,intermediate-risk,or high-risk PCa who underwent laparoscopic radical prostatectomy(LRP)and extended pelvic lymph node dissection(ePLND)without neoadjuvant hormonal therapy at a single institution from June 2013 to December 2016.In all 55 patients,the median number of lymph nodes(LNs)resected was 23(range:18-31),and a total of 1269 LNs were removed,of which 78 LNs were positive.Seventeen patients had positive LNs,with a positive rate of 30.9%.In addition,the immunohistochemical results in the above patients revealed that high TLR9 expression was correlated with higher Gleason score(GS)(P=0.049),increased LN metastasis(P=0.004),and more perineural invasion(PNI)(P=0.033).Moreover,VEGF-C expression was associated with GS(P=0.040),pathological stage(pT stage)(P=0.022),LN metastasis(P=0.003),and PNI(P=0.001).Furthermore,a significant positive correlation between TLR9 and VEGF-C was found(P<0.001),and the TLR9/VEGF-C phenotype was associated with LN metastasis(P=0.047).Collectively,we propose that TLR9 stimulation may promote LN metastasis in PCa cells through the upregulation of VEGF-C expression,thereby affecting the prognosis of PCa patients.Therefore,these markers may serve as valuable targets for the treatment of PCa.展开更多
Background Endometrial cancer(EC)has been one of the most general cancers with respect to gynecological malignancies;however,there are debates on clinical strategies concerning treatments especially for patients with ...Background Endometrial cancer(EC)has been one of the most general cancers with respect to gynecological malignancies;however,there are debates on clinical strategies concerning treatments especially for patients with grade 3(G3)endometroid endometrial cancer(EEC).Present study aimed to evaluate the lymphatic metastasis(LM)related factors and figure out the necessity of lymphadenectomy for G3 EEC patients.Methods From January 2009 to April 2019,3751 EC patients were admitted to Obstetrics and Gynecology Hospital of Fudan University.Clinical characteristics include age,grade,stage,and clinical pathological features.A total of 1235 EEC patients were involved in the multivariable analysis.Three hundred and eighty-one patients were involved in the survival analysis and the data attributed to sufficient follow-up information.Kaplan-Meier curve and log-rank test were utilized to analyze the survival rate.Results Among the 1235 EEC patients,181(14.7%)were categorized as G3 and 1054(85.3%)were grade 1 to grade 2(G1-2).Multivariate analysis demonstrated that lymphovascular space invasion,adnexal involvement,and cervical stroma involvement were independent risk factors of LM in G3 cohort with odds ratio 3.4,5.8,and 8.9;95%confidence interval 1.1–10.6,1.5–22.4,and 2.8–28.0,respectively.LM rates increased from 3.3%(3/92)to 75%(9/12)for G3 EEC cohort as related factor numbers increased from one to three.There were no differences between G3 and G1-2 EEC in overall survival and progression free survival.Additionally,no survival advantage was observed for G3 EEC patients at early stage with different plans of adjuvant treatment.Conclusions For G3 EEC patients without other pathological positive factor,theLMrate is lower than those with other pathological positive factor.Survival analysis showed no difference between G3 cohort and G1-2 cohort.Also,different adjuvant treatments had no impact on the overall survival for G3 EEC patients.展开更多
BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our ca...BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our case report also suffered from a breast carcinoma accompanied by left supraclavicular lymphadenopathy,which made it difficult to distinguish the origin of the CLNM.Based on this case,we recommended that more detailed physical and imaging examinations are needed for patients with uncommon cervical lymphatic metastasis of primary cancer.CASE SUMMARY A 53-year-old women was admitted to the hospital for a neck mass in the left cervical region that had existed for 2 mo.The neck mass was suspected to be an enlarged lateral LN originating from papillary thyroid microcarcinoma of the contralateral thyroid lobe,according to ultrasound and ultrasound-guided fine needle aspiration biopsy.The patient underwent total thyroidectomy and radical cervical LN dissection.Postoperative pathology confirmed the diagnosis of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis.Unfortunately,a breast cancer was discovered 4 mo later,which was accompanied by ipsilateral supraclavicular LN metastasis.She accepted neoadjuvant chemotherapy and subsequent left modified radical mastectomy for treatment.The patient is currently receiving postoperative radiotherapy,and no local recurrence was observed in the 6-mo follow-up after surgery.CONCLUSIONWe present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skipmetastasis and breast cancer with supraclavicular lymphatic metastasis.展开更多
Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection(LPLND) in improving parametrial lymph node(PLN) and its metastasis detection rate during radical hysterectomy f...Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection(LPLND) in improving parametrial lymph node(PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer.Methods: From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1-IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy(CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups.Results: Compared with CRH group, the rate of laparoscopic surgery was higher(60.3% vs. 15.9%, P<0.001),and the blood transfusion rate was lower(19.0% vs. 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases(96.7%) in the LPLND group, and 270 cases(11.6%) in the CRH group(P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group(median 3 vs. 1, P<0.001).The PLN metastases were detected in 25 cases(6.8%) in the LPLND group, and 18 cases(0.8%) in the CRH group(P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio(OR)=228.999, 95% confidence interval(95% CI): 124.661-420.664;P<0.001], but also for PLN metastasis identification(OR=10.867, 95% CI: 5.381-21.946;P<0.001).Conclusions: LPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer.展开更多
Objective:Lymph node status is critical when selecting treatment methods for patients with early gastric cancer(EGC).The aim of this study was to assess the diagnostic value of computed tomography(CT)for detection of ...Objective:Lymph node status is critical when selecting treatment methods for patients with early gastric cancer(EGC).The aim of this study was to assess the diagnostic value of computed tomography(CT)for detection of lymph node metastasis(LNM)in patients with EGC.Methods:We retrospectively analyzed patients who had pathologically confirmed EGC between November2010 and January 2019.After 1:1 propensity score matching,65 patients with LNM and 65 patients without LNM were retained for comparison.The long diameter(LD)and short diameter(SD)of all visualized lymph nodes in all stations were recorded.The diagnostic value of LNM was assessed with receiver operating characteristic analysis.Results:Among 130 patients,we found a total of 558 lymph nodes on the CT images.Among the diagnostic indicators,the number,sum of LD and sum of SD of lymph nodes greater than 3 mm had better discrimination.The areas under the curve were all greater than 0.75.As for different regions,the optimal cutoff values of number,the sum of LD and sum of SD were determined as follows:overall,≥4,19.9 mm and 13.5 mm;left gastric artery basin,≥3,15.7 mm and 8.6 mm;right gastroepiploic artery basin,≥2,8.6 mm and 7.0 mm.Conclusions:CT is valuable for diagnosing LNM in EGC patients.The number,sum of LD and sum of SD of lymph nodes greater than 3 mm are preferable indicators.Different regional lymph nodes have different optimal criteria for predicting LNM in ECG patients.展开更多
Objective This study aimed to investigate the occurrence of No.12 lymph node micrometastasis in patients with gastric cancer and its relationship with clinicopathological parameters and prognosis.Methods A cohort of 1...Objective This study aimed to investigate the occurrence of No.12 lymph node micrometastasis in patients with gastric cancer and its relationship with clinicopathological parameters and prognosis.Methods A cohort of 160 gastric cancer patients who underwent gastrectomy and lymph node dissection were selected as the research subjects.The immunohistochemical method was used to detect the micrometastasis of No.12 lymph node sections with negative routine pathological detection.At the same time,the clinical data of patients were collected and followed up to analyze the clinical significance of No.12 lymph node micrometastasis.Results A total of 370 No.12 lymph nodes were detected in 160 surgical specimens.Among 160 patients,27 patients were found to be positive for No.12 lymph nodes during routine pathological examination,with a positive rate of 16.8%.A total of 308 lymph nodes from 133 patients with negative routine pathological examinations were stained by immunohistochemistry.A total of 17 lymph nodes from 10 patients were found to be positive.The results showed that 37 of the 160 patients had No.12 lymph node metastasis,and the positive rate was 23.1%,which was 6.3%higher than that of routine pathological examination.Logistic multivariate analyses showed that the depth of invasion,lymph node metastasis in other groups,and clinical stage were independent risk factors for No.12 lymph node metastasis.The average follow-up time was 79.3 months,and the overall median survival time was 47.9 months.The survival time of the No.12 lymph node-negative group was 67.3±2.5Âmonths,the median survival time was 73.2 months;the survival time of the No.12 lymph node-positive group was(28.4±5.4)months,and the median survival time was 31.3 months.The survival time of the No.12 lymph node-negative group was significantly longer than that of the positive group(χ^(2)=12.75,P=0.000).Conclusion No.12 lymph node micrometastasis is a signal affecting the prognosis of patients with gastric cancer.Standardized dissection of No.12 lymph nodes is recommended for patients with gastric cancer who can undergo radical resection.展开更多
BACKGROUND Few studies compared the oncological and biological characteristics between ampullary carcinoma(AC) and cancer of the second portion of the duodenum(DC-Ⅱ), although both tumors arise from anatomically clos...BACKGROUND Few studies compared the oncological and biological characteristics between ampullary carcinoma(AC) and cancer of the second portion of the duodenum(DC-Ⅱ), although both tumors arise from anatomically close locations.AIM To elucidate differences in clinicopathological characteristics, especially the patterns of lymph node metastasis(LNM), between AC and DC-Ⅱ.METHODS This was a retrospective cohort study of 80 patients with AC and 27 patients with DC-Ⅱ who underwent pancreaticoduodenectomy between January 1998 and December 2018 in two institutions. Clinicopathological factors, LNM patterns, and prognosis were compared between the two groups.RESULTS The patients with AC and DC-Ⅱ did not exhibit significant differences in 5-year overall survival(66.0% and 67.1%, respectively) and 5-year relapse-free survival(63.5% and 62.2%, respectively). Compared to the patients with DC-Ⅱ, the rate of preoperative biliary drainage was higher(P = 0.042) and the rates of digestive symptoms(P = 0.0158), ulcerative-type cancer(P < 0.0001), large tumor diameter(P < 0.0001), and advanced tumor stage(P = 0.0019) were lower in the patients with AC. The LNM rates were 27.5% and 40.7% in patients with AC and DC-Ⅱ,respectively, without significant difference(P = 0.23). The rates of LNM to hepatic nodes(N-He)and pyloric nodes(N-Py) were significantly higher in patients with DC-Ⅱ than in those with AC(metastasis to N-HE: 18.5% and 5% in patients with DC-Ⅱ and AC, respectively;P = 0.0432;metastasis to N-Py: 11.1% and 0% in patients with DC-Ⅱ and AC, respectively;P = 0.0186)CONCLUSION Although there were no significant differences in the prognosis and recurrence rates between the two groups, metastases to N-He and N-Py were more frequent in patients with DC-Ⅱ than in those with AC.展开更多
Lymph node metastasis is the hallmark of colon cancer progression,and is considered one of the most important prognostic factors.Recently,there has been growing evidence that tumor lymphangiogenesis(formation of new l...Lymph node metastasis is the hallmark of colon cancer progression,and is considered one of the most important prognostic factors.Recently,there has been growing evidence that tumor lymphangiogenesis(formation of new lymphatic vessels) plays an important role in this process.Here,we review the latest f indings of the role of lymphangiogenesis in colorectal cancer progression,and discuss its clinical application as a biomarker and target for new therapy.Understanding the molecular pathways that regulate lymphangiogenesis is mandatory to pave the way for the development of new therapies for cancer.In the future,tailored treatments consisting of combinations of chemotherapy,other targeted therapies,and anti-lymphangiogenesis agents will hopefully improve patient outcomes.This progression to the clinic must be guided by new avenues of research,such as the identif ication of biomarkers that predict response to treatment.展开更多
BACKGROUND Lateral lymph node metastasis is one of the leading causes of local recurrence in patients with advanced mid or low rectal cancer.Neoadjuvant chemoradiotherapy(NCRT)can effectively reduce the postoperative ...BACKGROUND Lateral lymph node metastasis is one of the leading causes of local recurrence in patients with advanced mid or low rectal cancer.Neoadjuvant chemoradiotherapy(NCRT)can effectively reduce the postoperative recurrence rate;thus,NCRT with total mesorectal excision(TME)is the most widely accepted standard of care for rectal cancer.The addition of lateral lymph node dissection(LLND)after NCRT remains a controversial topic.AIM To investigate the surgical outcomes of TME plus LLND,and the possible risk factors for lateral lymph node metastasis after NCRT.METHODS This retrospective study reviewed 89 consecutive patients with clinical stage II-III mid or low rectal cancer who underwent TME and LLND from June 2016 to October 2018.In the NCRT group,TME plus LLND was performed in patients with short axis(SA)of the lateral lymph node greater than 5 mm.In the non-NCRT group,TME plus LLND was performed in patients with SA of the lateral lymph node greater than 10 mm.Data regarding patient demographics,clinical workup,surgical procedure,complications,and outcomes were collected.Multivariate logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in NCRT patients.RESULTS LLN metastasis was pathologically confirmed in 35 patients(39.3%):26(41.3%)in the NCRT group and 9(34.6%)in the non-NCRT group.The most common site of metastasis was around the obturator nerve(21/35)followed by the internal iliac artery region(12/35).In the NCRT patients,46%of patients with SA of LLN greater than 7 mm were positive.The postoperative 30-d mortality rate was 0%.Two(2.2%)patients suffered from lateral local recurrence in the 2-year follow up.Multivariate analysis showed that cT4 stage(odds ratio[OR]=5.124,95%confidence interval[CI]:1.419-18.508;P=0.013),poor differentiation type(OR=4.014,95%CI:1.038-15.520;P=0.044),and SA≥7 mm(OR=7.539,95%CI:1.487-38.214;P=0.015)were statistically significant risk factors associated with LLN metastasis.CONCLUSION NCRT is not sufficient as a stand-alone therapy to eradicate LLN metastasis in lower rectal cancer patients and surgeons should consider performing selective LLND in patients with greater LLN SA diameter,poorer histological differentiation,or advanced T stage.Selective LLND for NCRT patients can have a favorable oncological outcome.展开更多
Objective: The management of early-stage(cT1/2N0) oral squamous cell carcinoma(OSCC) remains a controversial issue. The aim of this study was to compare the clinical outcomes of neck observation(OBS) and elective neck...Objective: The management of early-stage(cT1/2N0) oral squamous cell carcinoma(OSCC) remains a controversial issue. The aim of this study was to compare the clinical outcomes of neck observation(OBS) and elective neck dissection(END) in treating patients with cT1/2N0 OSCC.Methods: A total of 232 patients with cT1/2N0 OSCC were included in this retrospective study. Of these patients, 181 were treated with END and 51 with OBS. The survival curves of 5-year overall survival(OS), diseasespecific survival(DSS), and recurrence-free survival(RFS) rates were plotted using the Kaplan-Meier method for each group, and compared using the Log-rank test.Results: There was no significant difference in 5-year OS and DSS rates between END and OBS groups(OS:89.0% vs. 88.2%, P=0.906; DSS: 92.3% vs. 92.2%, P=0.998). However, the END group had a higher 5-year RFS rate than the OBS group(90.1% vs. 76.5%, P=0.009). Patients with occult metastases in OBS group(7/51) had similar 5-year OS rate(57.1% vs. 64.1%, P=0.839) and DSS rate(71.4% vs. 74.4%, P=0.982) to those in END group(39/181). In the regional recurrence patients, the 5-year OS rate(57.1% vs. 11.1%, P=0.011) and DSS rate(71.4% vs. 22.2%, P=0.022) in OBS group(7/51) were higher than those in END group(9/181).Conclusions: The results indicated that OBS policy could obtain the same 5-year OS and DSS as END. Under close follow-up, OBS policy may be an available treatment option for patients with clinical T1/2N0 OSCC.展开更多
BACKGROUND Controversy exists about the benefit of additional surgery after endoscopic submucosal dissection(ESD)for early gastric cancer(EGC).AIM To examine risk factors for overall survival(OS)after additional surge...BACKGROUND Controversy exists about the benefit of additional surgery after endoscopic submucosal dissection(ESD)for early gastric cancer(EGC).AIM To examine risk factors for overall survival(OS)after additional surgery in patients with EGC who initially underwent ESD.METHODS This was a retrospective analysis of patients with EGC who underwent additional surgery after ESD at the Beijing Friendship Hospital affiliated to Capital Medical University between August 2012 and August 2019.OS was the primary outcome.Lymph node metastasis and residual tumor were secondary outcomes.Logistic regression models and Kaplan-Meier curves were used for further analysis.RESULTS Forty-two patients were evaluated,including 35(83.3%)males and 7(16.7%)females.The mean age was 62(range,32-82)years.Male sex[hazard ratio(HR)=21.906,95%confidence interval(CI):3.762-229.250;P=0.039),T1b invasion(HR=3.965,95%CI:1.109-17.432;P=0.047),undifferentiated tumor(HR=9.455,95%CI:0.946-29.482;P=0.049),lymph node metastasis(HR=2.126,95%CI:0.002-13.266;P=0.031),and residual tumor(HR=4.275,95%CI:1.049-27.420;P=0.043)were independently associated with OS.The follow-up duration was 4-81 mo(median:50.7 mo).OS was 77.0±12.1 mo(95%CI:53.3-100.7 mo).The 3-year and 5-year OS rates were 94.1%and 85%,respectively.CONCLUSION Male sex,T1b invasion,undifferentiated tumor,lymph node metastasis,and residual tumor are independently associated with OS in patients with EGC who underwent additional surgery after ESD.展开更多
BACKGROUND Although small colorectal neoplasms(<10 mm)are often easily resected endoscopically and are considered to have less malignant potential compared with large neoplasms(≥10 mm),some are invasive to the sub...BACKGROUND Although small colorectal neoplasms(<10 mm)are often easily resected endoscopically and are considered to have less malignant potential compared with large neoplasms(≥10 mm),some are invasive to the submucosa.AIM To clarify the clinicopathological features of small T1 colorectal cancers.METHODS Of 32025 colorectal lesions between April 2001 and March 2018,a total of 1152 T1 colorectal cancers resected endoscopically or surgically were included in this study and were divided into two groups by tumor size:a small group(<10 mm)and a large group(≥10 mm).We compared clinicopathological factors including lymph node metastasis(LNM)between the two groups.RESULTS The incidence of small T1 cancers was 10.1%(116/1152).The percentage of initial endoscopic treatment in small group was significantly higher than in large group(<10 mm 74.1%vs≥10 mm 60.2%,P<0.01).In the surgical resection cohort(n=798),the rate of LNM did not significantly differ between the two groups(small 12.3%vs large 10.9%,P=0.70).In addition,there were also no significant differences between the two groups in pathological factors such as histological grade,vascular invasion,or lymphatic invasion.CONCLUSION Because there was no significant difference in the rate of LNM between small and large T1 colorectal cancers,the requirement for additional surgical resection should be determined according to pathological findings,regardless of tumor size.展开更多
Objective:The main aim of this study was to establish a scoring model to predict risk of progression and survival in patients with regionally recurrent nasopharyngeal carcinoma(NPC).Methods:Three hundred and forty-eig...Objective:The main aim of this study was to establish a scoring model to predict risk of progression and survival in patients with regionally recurrent nasopharyngeal carcinoma(NPC).Methods:Three hundred and forty-eight patients subjected to neck dissection from 2003 to 2017 were included for study.Clinicopathologic information for each patient was analyzed.Independent prognostic factors were selected using the Cox proportional hazards model and incorporated into the scoring model.Concordance index(C-index)and calibration curves were used to verify discrimination and calibration,respectively and the results validated using bootstrap resampling.Results:Microscopic positive lymph node>2[hazard ratio(HR),2.19;95%confidence interval(CI),1.30–3.68;P=0.003],extranodal extension(HR,2.75;95%CI,1.69–4.47;P<0.001),and lower neck involvement(HR,1.78;95%CI,1.04–3.04;P=0.034)were identified from multivariate analysis as independent factors for overall survival(OS).A qualitative 4-point scale was generated to stratify patients into 4 risk groups for predicting OS and progression-free survival(PFS).The novel scoring model demonstrated enhanced discrimination(C-index=0.69;95%CI,0.62–0.76)relative to the original recurrent tumor-node-metastasis(rTNM)staging system(C-index=0.56;95%CI,0.50–0.62),and was internally validated with a bootstrap-adjusted C-index of 0.70.The calibration curve showed good agreement between predicted probabilities and actual observations.Conclusions:The scoring system established in this study based on a large regionally recurrent NPC cohort fills a gap regarding assessment of risk and prediction of survival outcomes after neck dissection in this population and could be further applied to identify high-risk patients who may benefit from more aggressive intervention.展开更多
The management of non-melanoma skin cancers metastatic to the neck is challenging due to variability in biological behavior and patterns of regional lymphatic spread.Metastatic non-melanoma skin cancers to the parotid...The management of non-melanoma skin cancers metastatic to the neck is challenging due to variability in biological behavior and patterns of regional lymphatic spread.Metastatic non-melanoma skin cancers to the parotid and neck often behave aggressively,with a high incidence of local recurrence after treatment and reduced five-year survival outcomes.Patterns of lymphatic spread are different from those seen in mucosal squamous cell carcinoma,with higher prevalence of disease in the parotid and superficial lymphatics.These factors require that treatment is individualized to achieve optimal outcomes.Traditionally,the management of non-melanoma skin cancers metastatic to lymph nodes has involved surgical excision followed by adjuvant radiation therapy.However,novel systemic therapies are showing promising results and their role in the management of these cancers is evolving.展开更多
Lymphography is often used for the diagnosis of lymphatic metastasis in oncology.Determination of lymphatic metastasis is extremely important for accurate cancer staging,which may directly guide the clinical therapeut...Lymphography is often used for the diagnosis of lymphatic metastasis in oncology.Determination of lymphatic metastasis is extremely important for accurate cancer staging,which may directly guide the clinical therapeutic scheme.In recent years,the technology of lymphography has developed rapidly on the basis of traditional lymphography,with the appearance of com-puted tomography(CT)lymphography,nuclear magnetic resonance(MR)lymphography,contrast-enhanced lym-phosonography,and so on;the diagnostic accuracy has also been improved.The imaging principles and methods of these various technologies of lymphography are reviewed in this paper,and their applications and significance in oncology are also discussed in detail.展开更多
基金supported by the National Natural Science Foundation of China(Grant No.82173303)Natural Science Foundation of Chongqing,China(Grant No.cstc2021ycjh-bgzxm0149).
文摘Lymphatic metastasis(LM)emerges as an independent prognostic marker for hypopharyngeal squamous cell carcinoma(HSPSCC),chiefly contributing to treatment inefficacy.This study aimed to scrutinize the prognostic relevance of HSP90AA1 and its potential regulatory mechanism of concerning LM in HPSCC.Methods:In a preceding investigation,HSP90AA1,a differential gene,was discovered through transcriptome sequencing of HPSCC tissues,considering both the presence and absence of LM.Validation of HSP90AA1 expression was accomplished via qRT-PCR,western-blotting(WB),and immunohistochemistry(IHC),while its prognostic significance was assessed employing Kaplan–Meier survival analysis(KMSA),log-rank test(LR),and Cox’s regression analysis(CRA).Bioinformatics techniques facilitated the prediction and analysis of its plausible mechanisms in LM,further substantiated by in vitro and in vivo experiments utilizing FaDu cell lines.Results:HSP90AA1 is substantially upregulated in HPSCC with LM and is identified as an independent prognostic risk determinant.The down-regulation of HSP90AA1 can achieve inhibition of tumor cell proliferation,migration and invasion.Both in vivo experiments and Bioinformatics exploration hint at promoting LM by Epithelial-mesenchymal transition(EMT),regulated by HSP90AA1.Conclusions:HSP90AA1,by controlling EMT,can foster LM in HPSCC.This finding sets the foundation for delving into new therapeutic targets for HPSCC.
基金National Key Research and Development Program of China,Grant/Award Number:2018YFA0902803National Natural Science Foundation of China,Grant/Award Numbers:81825016,82072827,81961128027,81702523,81972383,82102957+5 种基金Guangdong Basic and Applied Basic Research Foundation,Grant/Award Numbers:2021B1515020009,2020A1515010888,2019A1515010188Science and Technology Program of Guangzhou,Grant/Award Number:202102010002Guangdong Special Support Program,Grant/Award Number:2017TX04R246Guangdong Province Higher Vocational Colleges&Schools Pearl River Scholar Funded Scheme(for Tianxin Lin)Guangdong Provincial Clinical Research Center for Urological Diseases,Grant/Award Number:2020B1111170006Guangdong Science and Technology Department,Grant/Award Numbers:2020B1212060018,2018B030317001。
文摘Background:Lymphatic metastasis has been associated with poor prognosis in bladder cancer patients with limited therapeutic options.Emerging evidence shows that heat shock factor 1(HSF1)drives diversified transcriptome to promote tumor growth and serves as a promising therapeutic target.However,the roles of HSF1 in lymphatic metastasis remain largely unknown.Herein,we aimed to illustrate the clinical roles and mechanisms of HSF1 in the lymphatic metastasis of bladder cancer and explore its therapeutic potential.Methods:We screened the most relevant gene to lymphatic metastasis among overexpressed heat shock factors(HSFs)and heat shock proteins(HSPs),and analyzed its clinical relevance in three cohorts.Functional in vitro and in vivo assays were performed in HSF1-silenced and-regained models.We also used Coimmunoprecipitation to identify the binding proteins of HSF1 and chromatin immunoprecipitation and dual-luciferase reporter assays to investigate the transcriptional program directed by HSF1.The pharmacological inhibitor of HSF1,KRIBB11,was evaluated in popliteal lymph node metastasis models and patientderived xenograft models of bladder cancer.Results:HSF1 expression was positively associated with lymphatic metastasis status,tumor stage,advanced grade,and poor prognosis of bladder cancer.Importantly,HSF1 enhanced the epithelial-mesenchymal transition(EMT)of cancer cells in primary tumor to initiate metastasis,proliferation of cancer cells in lymph nodes,and macrophages infiltration to facilitate multistep lymphatic metastasis.Mechanistically,HSF1 interacted with protein arginine methyltransferase 5(PRMT5)and jointly induced the monomethylation of histone H3 at arginine 2(H3R2me1)and symmetric dimethylation of histone H3 at arginine 2(H3R2me2s).This recruited the WD repeat domain 5(WDR5)/mixed-lineage leukemia(MLL)complex to increase the trimethylation of histone H3 at lysine 4(H3K4me3);resulting in upregulation of lymphoid enhancer-binding factor 1(LEF1),matrix metallopeptidase 9(MMP9),C-C motif chemokine ligand 20(CCL20),and E2F transcription factor 2(E2F2).Application of KRIBB11 significantly inhibited the lymphatic metastasis of bladder cancer with no significant toxicity.Conclusion:Our findings reveal a novel transcriptional program directed by the HSF1-PRMT5-WDR5 axis during the multistep process of lymphatic metastasis in bladder cancer.Targeting HSF1 could be a multipotent and promising therapeutic strategy for bladder cancer patients with lymphatic metastasis.
文摘BACKGROUND Upper gastrointestinal neoplasia mainly includes esophageal cancer and gastric cancer,both of which have high morbidity and mortality.Lymph node metastasis(LNM),as the most common metastasis mode of both diseases,is an important factor affecting tumor stage,treatment strategy and clinical prognosis.As a new fusion technology,endoscopic ultrasound(EUS)is becoming increasingly used in the diagnosis and treatment of digestive system diseases,but its use in detecting LNM in clinical practice remains limited.AIM To evaluate the diagnostic value of conventional EUS for LNM in upper gastrointestinal neoplasia.METHODS Using the search mode of“MeSH+Entry Terms”and according to the predetermined inclusion and exclusion criteria,we conducted a comprehensive search and screening of the PubMed,EMBASE and Cochrane Library databases from January 1,2000 to October 1,2022.Study data were extracted according to the predetermined data extraction form.The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool,and the results of the quality assessment were presented using Review Manager 5.3.5 software.Finally,Stata14.0 software was used for a series of statistical analyses.RESULTS A total of 22 studies were included in our study,including 2986 patients.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic score and diagnostic odds ratio of conventional EUS in the diagnosis of upper gastrointestinal neoplasia LNM were 0.62[95%confidence interval(CI):0.50-0.73],0.80(95%CI:0.73-0.86),3.15(95%CI:2.46-4.03),0.47(95%CI:0.36-0.61),1.90(95%CI:1.51-2.29)and 6.67(95%CI:4.52-9.84),respectively.The area under the summary receiver operating characteristic curve was 0.80(95%CI:0.76-0.83).Sensitivity analysis indicated that the results of the meta-analysis were stable.There was considerable heterogeneity among the included studies,and the threshold effect was an important source of heterogeneity.Univariable meta-regression and subgroup analysis showed that tumor type,sample size and EUS diagnostic criteria were significant sources of heterogeneity in specificity(P<0.05).No significant publication bias was found.CONCLUSION Conventional EUS has certain clinical value and can assist in the detection of LNM in upper gastrointestinal neoplasia,but it cannot be used as a confirmatory or exclusionary test.
基金supported by grants from the Natural Science Foundation of Guangdong Province(No.2018A030313261 and No.2021Al515010129)Guangdong Medical Science and Technology Research Foundation(No.A2018079)the National Natural Science Foundation of China(No.81772752).
文摘Prostate cancer(PCa)is one of the most frequent cancers in men,and its biomolecular targets have been extensively studied.This study aimed to analyze the expression of toll-like receptor 9(TLR9)and vascular endothelial growth factor C(VEGF-C)and the clinical value of the coexpression of TLR9 and VEGF-C in PCa.We retrospectively evaluated 55 patients with clinically localized,intermediate-risk,or high-risk PCa who underwent laparoscopic radical prostatectomy(LRP)and extended pelvic lymph node dissection(ePLND)without neoadjuvant hormonal therapy at a single institution from June 2013 to December 2016.In all 55 patients,the median number of lymph nodes(LNs)resected was 23(range:18-31),and a total of 1269 LNs were removed,of which 78 LNs were positive.Seventeen patients had positive LNs,with a positive rate of 30.9%.In addition,the immunohistochemical results in the above patients revealed that high TLR9 expression was correlated with higher Gleason score(GS)(P=0.049),increased LN metastasis(P=0.004),and more perineural invasion(PNI)(P=0.033).Moreover,VEGF-C expression was associated with GS(P=0.040),pathological stage(pT stage)(P=0.022),LN metastasis(P=0.003),and PNI(P=0.001).Furthermore,a significant positive correlation between TLR9 and VEGF-C was found(P<0.001),and the TLR9/VEGF-C phenotype was associated with LN metastasis(P=0.047).Collectively,we propose that TLR9 stimulation may promote LN metastasis in PCa cells through the upregulation of VEGF-C expression,thereby affecting the prognosis of PCa patients.Therefore,these markers may serve as valuable targets for the treatment of PCa.
基金This work was supported in part by grants from the National Natural Science Foundation of China(No.81772777)Shanghai Science and TechnologyCommission Medical Guidance Project(No.18411963700)+1 种基金Clinical Research Plan of SHDC(No.SHDC2020CR4079)Shanghai“Pujiang Talents”Project(No.17PJ1401400).
文摘Background Endometrial cancer(EC)has been one of the most general cancers with respect to gynecological malignancies;however,there are debates on clinical strategies concerning treatments especially for patients with grade 3(G3)endometroid endometrial cancer(EEC).Present study aimed to evaluate the lymphatic metastasis(LM)related factors and figure out the necessity of lymphadenectomy for G3 EEC patients.Methods From January 2009 to April 2019,3751 EC patients were admitted to Obstetrics and Gynecology Hospital of Fudan University.Clinical characteristics include age,grade,stage,and clinical pathological features.A total of 1235 EEC patients were involved in the multivariable analysis.Three hundred and eighty-one patients were involved in the survival analysis and the data attributed to sufficient follow-up information.Kaplan-Meier curve and log-rank test were utilized to analyze the survival rate.Results Among the 1235 EEC patients,181(14.7%)were categorized as G3 and 1054(85.3%)were grade 1 to grade 2(G1-2).Multivariate analysis demonstrated that lymphovascular space invasion,adnexal involvement,and cervical stroma involvement were independent risk factors of LM in G3 cohort with odds ratio 3.4,5.8,and 8.9;95%confidence interval 1.1–10.6,1.5–22.4,and 2.8–28.0,respectively.LM rates increased from 3.3%(3/92)to 75%(9/12)for G3 EEC cohort as related factor numbers increased from one to three.There were no differences between G3 and G1-2 EEC in overall survival and progression free survival.Additionally,no survival advantage was observed for G3 EEC patients at early stage with different plans of adjuvant treatment.Conclusions For G3 EEC patients without other pathological positive factor,theLMrate is lower than those with other pathological positive factor.Survival analysis showed no difference between G3 cohort and G1-2 cohort.Also,different adjuvant treatments had no impact on the overall survival for G3 EEC patients.
基金Supported by The Project of Shanghai Municipal Health Commission,No. 20214Y0223
文摘BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our case report also suffered from a breast carcinoma accompanied by left supraclavicular lymphadenopathy,which made it difficult to distinguish the origin of the CLNM.Based on this case,we recommended that more detailed physical and imaging examinations are needed for patients with uncommon cervical lymphatic metastasis of primary cancer.CASE SUMMARY A 53-year-old women was admitted to the hospital for a neck mass in the left cervical region that had existed for 2 mo.The neck mass was suspected to be an enlarged lateral LN originating from papillary thyroid microcarcinoma of the contralateral thyroid lobe,according to ultrasound and ultrasound-guided fine needle aspiration biopsy.The patient underwent total thyroidectomy and radical cervical LN dissection.Postoperative pathology confirmed the diagnosis of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis.Unfortunately,a breast cancer was discovered 4 mo later,which was accompanied by ipsilateral supraclavicular LN metastasis.She accepted neoadjuvant chemotherapy and subsequent left modified radical mastectomy for treatment.The patient is currently receiving postoperative radiotherapy,and no local recurrence was observed in the 6-mo follow-up after surgery.CONCLUSIONWe present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skipmetastasis and breast cancer with supraclavicular lymphatic metastasis.
基金special fund for “Capital City Clinical Specific Application Study”(No.Z171100001017115)。
文摘Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection(LPLND) in improving parametrial lymph node(PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer.Methods: From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1-IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy(CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups.Results: Compared with CRH group, the rate of laparoscopic surgery was higher(60.3% vs. 15.9%, P<0.001),and the blood transfusion rate was lower(19.0% vs. 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases(96.7%) in the LPLND group, and 270 cases(11.6%) in the CRH group(P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group(median 3 vs. 1, P<0.001).The PLN metastases were detected in 25 cases(6.8%) in the LPLND group, and 18 cases(0.8%) in the CRH group(P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio(OR)=228.999, 95% confidence interval(95% CI): 124.661-420.664;P<0.001], but also for PLN metastasis identification(OR=10.867, 95% CI: 5.381-21.946;P<0.001).Conclusions: LPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer.
基金supported by Beijing Hospitals Authority Clinical Medicine Development of special funding(No.XMLX202119)Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals(No.XXT20)。
文摘Objective:Lymph node status is critical when selecting treatment methods for patients with early gastric cancer(EGC).The aim of this study was to assess the diagnostic value of computed tomography(CT)for detection of lymph node metastasis(LNM)in patients with EGC.Methods:We retrospectively analyzed patients who had pathologically confirmed EGC between November2010 and January 2019.After 1:1 propensity score matching,65 patients with LNM and 65 patients without LNM were retained for comparison.The long diameter(LD)and short diameter(SD)of all visualized lymph nodes in all stations were recorded.The diagnostic value of LNM was assessed with receiver operating characteristic analysis.Results:Among 130 patients,we found a total of 558 lymph nodes on the CT images.Among the diagnostic indicators,the number,sum of LD and sum of SD of lymph nodes greater than 3 mm had better discrimination.The areas under the curve were all greater than 0.75.As for different regions,the optimal cutoff values of number,the sum of LD and sum of SD were determined as follows:overall,≥4,19.9 mm and 13.5 mm;left gastric artery basin,≥3,15.7 mm and 8.6 mm;right gastroepiploic artery basin,≥2,8.6 mm and 7.0 mm.Conclusions:CT is valuable for diagnosing LNM in EGC patients.The number,sum of LD and sum of SD of lymph nodes greater than 3 mm are preferable indicators.Different regional lymph nodes have different optimal criteria for predicting LNM in ECG patients.
基金Supported by a grant from the Hebei Medical Science Research Project(No.20191831).
文摘Objective This study aimed to investigate the occurrence of No.12 lymph node micrometastasis in patients with gastric cancer and its relationship with clinicopathological parameters and prognosis.Methods A cohort of 160 gastric cancer patients who underwent gastrectomy and lymph node dissection were selected as the research subjects.The immunohistochemical method was used to detect the micrometastasis of No.12 lymph node sections with negative routine pathological detection.At the same time,the clinical data of patients were collected and followed up to analyze the clinical significance of No.12 lymph node micrometastasis.Results A total of 370 No.12 lymph nodes were detected in 160 surgical specimens.Among 160 patients,27 patients were found to be positive for No.12 lymph nodes during routine pathological examination,with a positive rate of 16.8%.A total of 308 lymph nodes from 133 patients with negative routine pathological examinations were stained by immunohistochemistry.A total of 17 lymph nodes from 10 patients were found to be positive.The results showed that 37 of the 160 patients had No.12 lymph node metastasis,and the positive rate was 23.1%,which was 6.3%higher than that of routine pathological examination.Logistic multivariate analyses showed that the depth of invasion,lymph node metastasis in other groups,and clinical stage were independent risk factors for No.12 lymph node metastasis.The average follow-up time was 79.3 months,and the overall median survival time was 47.9 months.The survival time of the No.12 lymph node-negative group was 67.3±2.5Âmonths,the median survival time was 73.2 months;the survival time of the No.12 lymph node-positive group was(28.4±5.4)months,and the median survival time was 31.3 months.The survival time of the No.12 lymph node-negative group was significantly longer than that of the positive group(χ^(2)=12.75,P=0.000).Conclusion No.12 lymph node micrometastasis is a signal affecting the prognosis of patients with gastric cancer.Standardized dissection of No.12 lymph nodes is recommended for patients with gastric cancer who can undergo radical resection.
文摘BACKGROUND Few studies compared the oncological and biological characteristics between ampullary carcinoma(AC) and cancer of the second portion of the duodenum(DC-Ⅱ), although both tumors arise from anatomically close locations.AIM To elucidate differences in clinicopathological characteristics, especially the patterns of lymph node metastasis(LNM), between AC and DC-Ⅱ.METHODS This was a retrospective cohort study of 80 patients with AC and 27 patients with DC-Ⅱ who underwent pancreaticoduodenectomy between January 1998 and December 2018 in two institutions. Clinicopathological factors, LNM patterns, and prognosis were compared between the two groups.RESULTS The patients with AC and DC-Ⅱ did not exhibit significant differences in 5-year overall survival(66.0% and 67.1%, respectively) and 5-year relapse-free survival(63.5% and 62.2%, respectively). Compared to the patients with DC-Ⅱ, the rate of preoperative biliary drainage was higher(P = 0.042) and the rates of digestive symptoms(P = 0.0158), ulcerative-type cancer(P < 0.0001), large tumor diameter(P < 0.0001), and advanced tumor stage(P = 0.0019) were lower in the patients with AC. The LNM rates were 27.5% and 40.7% in patients with AC and DC-Ⅱ,respectively, without significant difference(P = 0.23). The rates of LNM to hepatic nodes(N-He)and pyloric nodes(N-Py) were significantly higher in patients with DC-Ⅱ than in those with AC(metastasis to N-HE: 18.5% and 5% in patients with DC-Ⅱ and AC, respectively;P = 0.0432;metastasis to N-Py: 11.1% and 0% in patients with DC-Ⅱ and AC, respectively;P = 0.0186)CONCLUSION Although there were no significant differences in the prognosis and recurrence rates between the two groups, metastases to N-He and N-Py were more frequent in patients with DC-Ⅱ than in those with AC.
基金Supported by SUMITOMO Life Social Welfare Services Foundation (to Nagahashi M)Virginia Commonwealth University Grant BIRCWH K12HD055881,and Susan G Komen for the Cure Career Catalyst Research Grant KG090510 (to Takabe K)
文摘Lymph node metastasis is the hallmark of colon cancer progression,and is considered one of the most important prognostic factors.Recently,there has been growing evidence that tumor lymphangiogenesis(formation of new lymphatic vessels) plays an important role in this process.Here,we review the latest f indings of the role of lymphangiogenesis in colorectal cancer progression,and discuss its clinical application as a biomarker and target for new therapy.Understanding the molecular pathways that regulate lymphangiogenesis is mandatory to pave the way for the development of new therapies for cancer.In the future,tailored treatments consisting of combinations of chemotherapy,other targeted therapies,and anti-lymphangiogenesis agents will hopefully improve patient outcomes.This progression to the clinic must be guided by new avenues of research,such as the identif ication of biomarkers that predict response to treatment.
基金Supported by the Medicine and Health Technology Innovation Project of Chinese Academy of Medical Sciences,No.2017-12M-1-006China Scholarship Council,No.CSC201906210471.
文摘BACKGROUND Lateral lymph node metastasis is one of the leading causes of local recurrence in patients with advanced mid or low rectal cancer.Neoadjuvant chemoradiotherapy(NCRT)can effectively reduce the postoperative recurrence rate;thus,NCRT with total mesorectal excision(TME)is the most widely accepted standard of care for rectal cancer.The addition of lateral lymph node dissection(LLND)after NCRT remains a controversial topic.AIM To investigate the surgical outcomes of TME plus LLND,and the possible risk factors for lateral lymph node metastasis after NCRT.METHODS This retrospective study reviewed 89 consecutive patients with clinical stage II-III mid or low rectal cancer who underwent TME and LLND from June 2016 to October 2018.In the NCRT group,TME plus LLND was performed in patients with short axis(SA)of the lateral lymph node greater than 5 mm.In the non-NCRT group,TME plus LLND was performed in patients with SA of the lateral lymph node greater than 10 mm.Data regarding patient demographics,clinical workup,surgical procedure,complications,and outcomes were collected.Multivariate logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in NCRT patients.RESULTS LLN metastasis was pathologically confirmed in 35 patients(39.3%):26(41.3%)in the NCRT group and 9(34.6%)in the non-NCRT group.The most common site of metastasis was around the obturator nerve(21/35)followed by the internal iliac artery region(12/35).In the NCRT patients,46%of patients with SA of LLN greater than 7 mm were positive.The postoperative 30-d mortality rate was 0%.Two(2.2%)patients suffered from lateral local recurrence in the 2-year follow up.Multivariate analysis showed that cT4 stage(odds ratio[OR]=5.124,95%confidence interval[CI]:1.419-18.508;P=0.013),poor differentiation type(OR=4.014,95%CI:1.038-15.520;P=0.044),and SA≥7 mm(OR=7.539,95%CI:1.487-38.214;P=0.015)were statistically significant risk factors associated with LLN metastasis.CONCLUSION NCRT is not sufficient as a stand-alone therapy to eradicate LLN metastasis in lower rectal cancer patients and surgeons should consider performing selective LLND in patients with greater LLN SA diameter,poorer histological differentiation,or advanced T stage.Selective LLND for NCRT patients can have a favorable oncological outcome.
基金supported by grants from National Natural Science Foundation of China (No. 81372884 and No. 81672679)5010 Project of Clinical Study, Sun Yat-sen University (No. 2010018)
文摘Objective: The management of early-stage(cT1/2N0) oral squamous cell carcinoma(OSCC) remains a controversial issue. The aim of this study was to compare the clinical outcomes of neck observation(OBS) and elective neck dissection(END) in treating patients with cT1/2N0 OSCC.Methods: A total of 232 patients with cT1/2N0 OSCC were included in this retrospective study. Of these patients, 181 were treated with END and 51 with OBS. The survival curves of 5-year overall survival(OS), diseasespecific survival(DSS), and recurrence-free survival(RFS) rates were plotted using the Kaplan-Meier method for each group, and compared using the Log-rank test.Results: There was no significant difference in 5-year OS and DSS rates between END and OBS groups(OS:89.0% vs. 88.2%, P=0.906; DSS: 92.3% vs. 92.2%, P=0.998). However, the END group had a higher 5-year RFS rate than the OBS group(90.1% vs. 76.5%, P=0.009). Patients with occult metastases in OBS group(7/51) had similar 5-year OS rate(57.1% vs. 64.1%, P=0.839) and DSS rate(71.4% vs. 74.4%, P=0.982) to those in END group(39/181). In the regional recurrence patients, the 5-year OS rate(57.1% vs. 11.1%, P=0.011) and DSS rate(71.4% vs. 22.2%, P=0.022) in OBS group(7/51) were higher than those in END group(9/181).Conclusions: The results indicated that OBS policy could obtain the same 5-year OS and DSS as END. Under close follow-up, OBS policy may be an available treatment option for patients with clinical T1/2N0 OSCC.
基金Beijing Municipal Science&Technology Commission,No.D171100006517003Beijing Municipal Administration of Hospitals Incubating Program,No.PX2020001.
文摘BACKGROUND Controversy exists about the benefit of additional surgery after endoscopic submucosal dissection(ESD)for early gastric cancer(EGC).AIM To examine risk factors for overall survival(OS)after additional surgery in patients with EGC who initially underwent ESD.METHODS This was a retrospective analysis of patients with EGC who underwent additional surgery after ESD at the Beijing Friendship Hospital affiliated to Capital Medical University between August 2012 and August 2019.OS was the primary outcome.Lymph node metastasis and residual tumor were secondary outcomes.Logistic regression models and Kaplan-Meier curves were used for further analysis.RESULTS Forty-two patients were evaluated,including 35(83.3%)males and 7(16.7%)females.The mean age was 62(range,32-82)years.Male sex[hazard ratio(HR)=21.906,95%confidence interval(CI):3.762-229.250;P=0.039),T1b invasion(HR=3.965,95%CI:1.109-17.432;P=0.047),undifferentiated tumor(HR=9.455,95%CI:0.946-29.482;P=0.049),lymph node metastasis(HR=2.126,95%CI:0.002-13.266;P=0.031),and residual tumor(HR=4.275,95%CI:1.049-27.420;P=0.043)were independently associated with OS.The follow-up duration was 4-81 mo(median:50.7 mo).OS was 77.0±12.1 mo(95%CI:53.3-100.7 mo).The 3-year and 5-year OS rates were 94.1%and 85%,respectively.CONCLUSION Male sex,T1b invasion,undifferentiated tumor,lymph node metastasis,and residual tumor are independently associated with OS in patients with EGC who underwent additional surgery after ESD.
文摘BACKGROUND Although small colorectal neoplasms(<10 mm)are often easily resected endoscopically and are considered to have less malignant potential compared with large neoplasms(≥10 mm),some are invasive to the submucosa.AIM To clarify the clinicopathological features of small T1 colorectal cancers.METHODS Of 32025 colorectal lesions between April 2001 and March 2018,a total of 1152 T1 colorectal cancers resected endoscopically or surgically were included in this study and were divided into two groups by tumor size:a small group(<10 mm)and a large group(≥10 mm).We compared clinicopathological factors including lymph node metastasis(LNM)between the two groups.RESULTS The incidence of small T1 cancers was 10.1%(116/1152).The percentage of initial endoscopic treatment in small group was significantly higher than in large group(<10 mm 74.1%vs≥10 mm 60.2%,P<0.01).In the surgical resection cohort(n=798),the rate of LNM did not significantly differ between the two groups(small 12.3%vs large 10.9%,P=0.70).In addition,there were also no significant differences between the two groups in pathological factors such as histological grade,vascular invasion,or lymphatic invasion.CONCLUSION Because there was no significant difference in the rate of LNM between small and large T1 colorectal cancers,the requirement for additional surgical resection should be determined according to pathological findings,regardless of tumor size.
基金supported by grants from the National Key R&D Program of China(Grant Nos.2017YFC1309003 and 2017YFC0908500)National Natural Science Foundation of China(Grant Nos.81425018,81672868,81802775,and 81602371)+10 种基金Sci-Tech Project Foundation of Guangzhou City(Grant No.201707020039)Sun Yat-sen University Clinical Research 5010 ProgramSpecial Support Plan of Guangdong Province(Grant No.2014TX01R145)Natural Science Foundation of Guangdong Province(Grant Nos.2017A030312003 and 2018A0303131004)Sci-Tech Project Foundation of Guangdong Province(Grant No.2014A020212103)Health&Medical Collaborative Innovation Project of Guangzhou City(Grant Nos.201400000001 and 201803040003)Planned Science and Technology Project of Guangdong Province(Grant No.2019B020230002)National Science&Technology Pillar Program during the Twelfth FiveYear Plan Period(Grant No.2014BAI09B10)Natural Science Foundation of Guangdong Province for Distinguished Young Scholar(Grant No.2018B030306001)Pearl River S&T Nova Program of Guangzhou(Grant No.201806010135)PhD Start-up Fund of Natural Science Foundation of Guangdong Province(Grant No.2016A030310221)。
文摘Objective:The main aim of this study was to establish a scoring model to predict risk of progression and survival in patients with regionally recurrent nasopharyngeal carcinoma(NPC).Methods:Three hundred and forty-eight patients subjected to neck dissection from 2003 to 2017 were included for study.Clinicopathologic information for each patient was analyzed.Independent prognostic factors were selected using the Cox proportional hazards model and incorporated into the scoring model.Concordance index(C-index)and calibration curves were used to verify discrimination and calibration,respectively and the results validated using bootstrap resampling.Results:Microscopic positive lymph node>2[hazard ratio(HR),2.19;95%confidence interval(CI),1.30–3.68;P=0.003],extranodal extension(HR,2.75;95%CI,1.69–4.47;P<0.001),and lower neck involvement(HR,1.78;95%CI,1.04–3.04;P=0.034)were identified from multivariate analysis as independent factors for overall survival(OS).A qualitative 4-point scale was generated to stratify patients into 4 risk groups for predicting OS and progression-free survival(PFS).The novel scoring model demonstrated enhanced discrimination(C-index=0.69;95%CI,0.62–0.76)relative to the original recurrent tumor-node-metastasis(rTNM)staging system(C-index=0.56;95%CI,0.50–0.62),and was internally validated with a bootstrap-adjusted C-index of 0.70.The calibration curve showed good agreement between predicted probabilities and actual observations.Conclusions:The scoring system established in this study based on a large regionally recurrent NPC cohort fills a gap regarding assessment of risk and prediction of survival outcomes after neck dissection in this population and could be further applied to identify high-risk patients who may benefit from more aggressive intervention.
文摘The management of non-melanoma skin cancers metastatic to the neck is challenging due to variability in biological behavior and patterns of regional lymphatic spread.Metastatic non-melanoma skin cancers to the parotid and neck often behave aggressively,with a high incidence of local recurrence after treatment and reduced five-year survival outcomes.Patterns of lymphatic spread are different from those seen in mucosal squamous cell carcinoma,with higher prevalence of disease in the parotid and superficial lymphatics.These factors require that treatment is individualized to achieve optimal outcomes.Traditionally,the management of non-melanoma skin cancers metastatic to lymph nodes has involved surgical excision followed by adjuvant radiation therapy.However,novel systemic therapies are showing promising results and their role in the management of these cancers is evolving.
基金supported by the National Natural Science Foundation of China(Grant No.30770564).
文摘Lymphography is often used for the diagnosis of lymphatic metastasis in oncology.Determination of lymphatic metastasis is extremely important for accurate cancer staging,which may directly guide the clinical therapeutic scheme.In recent years,the technology of lymphography has developed rapidly on the basis of traditional lymphography,with the appearance of com-puted tomography(CT)lymphography,nuclear magnetic resonance(MR)lymphography,contrast-enhanced lym-phosonography,and so on;the diagnostic accuracy has also been improved.The imaging principles and methods of these various technologies of lymphography are reviewed in this paper,and their applications and significance in oncology are also discussed in detail.
