Objective To explore risk factors of lymph node metastasis (LNM) in T1 rectal cancer. Methods The retrospective case-control study was conducted. The clinicopathologic data of 247 patients with T1 rectal cancer underwent radical resection were analyzed in the pathological database of the West China Hospital from January 2000 to December 2016, including the tumor size (maximum diameter), gross type, differentiation degree, histological type, lymph vascular infiltration, perineural infiltration, and carcinoma nodule. The univariate analysis and multivariate analysis were done using the Chi-square test and logistic regression model, respectively. Results The rate of LNM in the patients with T1 rectal cancer was 8.50% (21/247). No lymph metastasis was found in the well differentiated T1 rectal cancer. The results of the univariate analysis showed that the differentiation degree, histological type, and carcinoma nodule were related to the LNM in the T1 rectal cancer (P<0.050). The results of the multivariate analysis revealed that the poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule were the independent risk factors of the LNM in the T1 rectal cancer (OR=9.75, P=0.006; OR=5.98, P=0.042; OR=8.33, P=0.017; OR=10.87, P=0.026). Conclusion In this large population dataset, poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule are risk factors of LNM in T1 rectal cancer.
Objective To explore the predictive value of CT signs combined with clinicopathological features for single cN0 papillary thyroid microcarcinoma (PTMC) central lymph node metastasis (CLNM). Methods A retrospective analysis of the CT signs and clinicopathological characteristics of 115 cases of single cN0 PTMC confirmed by surgery and pathology was performed, and univariate and multivariate logistic regression analysis were used to analyze the relationship between the contact between tumor and thyroid edge, tumor calcification, tumor location, tumor diameter, age, gender, thyroglobulin level and CLNM. According to the different contact range between tumor and thyroid edge in CT signs, the patients were divided into three groups: <1/4 group, 1/4–<1/2 group and ≥1/2 group. The proportion of CLNM positive patients in different contact areas between tumor body and thyroid edge was analyzed by using χ2 test. Results Among 115 cases of single cN0 PTMC, there were 26 cases and 89 cases with CLNM positive and negative, respectively. Univariate analysis showed that contact between tumor body and thyroid edge, tumor diameter, age, and gender were associated with CLNM positive (P<0.05). Further multivariate logistic regression analysis showed that thyroid marginal contact, age <45 years old and male were associated with CLNM positive (P<0.05). The proportion of CLNM positive patients in different contact areas between tumor body and thyroid edge (between the three groups ) was statistically different (P<0.05). The pairwise comparison among the three groups showed that the proportion of CLNM positive patients were statistically different (P<0.0167 after correction). Conclusions Tumor body contact with thyroid edge, age <45 years and male were independent risk factors for CLNM in patients with single cN0 PTMC. The combination of multiple risk factors can further improve the preoperative evaluation level of CLNM in patients with PTMC. Excluding clinical characteristic factors, the wider the contact area between the tumor and the thyroid edge, the higher the risk of CLNM, which provides a reasonable basis for selective central lymph node dissection.
Objective To investigate the proportions of CD4+ T cells, CD8+ T cells, and mutant of p53 gene in the microenvironment of breast infiltrating ductal carcinoma, and to explore its’ correlation with prognosis of breast infiltrating ductal carcinoma. Methods Eighty-five cases of breast infiltrating ductal carcinoma were collected who underwent surgery in the 371st Central Hospital of Peoples’ Liberation Army from 2010 to 2012, and then detected the proportion of CD4+ T cells and CD8+ T cells, ratio of CD4+ T cells to CD8+ T cells, and mutant of p53 gene in the cancer tissues with immunohistochemistry. Comparison between the sentinel lymph node metastasis group and non-sentinel lymph node metastasis group, mutant of p53 gene group and non-mutant of p53 gene group on the proportions of CD4+ T cells, CD8+ T cells, and ratio of CD4+ T cells to CD8+ T cells were performed, as well as the relationship between proportion of CD8+ T cells/mutant of p53 gene and prognosis of breast infiltrating ductal carcinoma. Results ① The relationship between proportion of CD4+ T cells/proportion of CD8+ T cells/ratio of CD4+ T cells to CD8+ T cells and situation of sentinel lymph node metastasis: at cluster, compared with the sentinel lymph node metastasis group, the proportion of CD8+ T cells was lower in the non-sentinel lymph node metastasis group (P<0.05), but there was no significant difference on the proportion of CD4+ T cells and ratio of CD4+ T cells to CD8+ T cells (P>0.05); at stroma, compared with the sentinel lymph node metastasis group, the proportions of CD4+ T cells and CD8+ T cells were lower, but the ratio of CD4+ T cells to CD8+ T cells was higher in the non-sentinel lymph node metastasis group (P<0.05). ② The relationship between proportion of CD4+ T cells/proportion of CD8+ T cells/ratio of CD4+ T cells to CD8+ T cells and mutant of p53 gene: both at the cluster and stroma, compared with the mutant of p53 gene group, the proportions of CD4+ T cells and CD8+ T cells were lower, but the ratio of CD4+ T cells to CD8+ T cells was higher in the non-mutant of p53 gene group (P<0.05). ③ The relationship between proportion of CD8+ T cells/mutant of p53 gene and prognosis of breast infiltrating ductal carcinoma: the prognosis was worse in patients with high degree of infiltration of CD8+ T cells and mutant of p53 gene than those patients with low degree of infiltration of CD8+ T cells and non-mutant of p53 gene (P<0.05). Conclusions The proportions of CD4+ T cells and CD8+ T cells, and ratio of CD4+ T cells to CD8+ T cells are associated with the situation of sentinel lymph node metastasis and mutant of p53 gene, and the degree of infiltration of CD8+ T cells and mutant of p53 gene are associated with the prognosis of breast infiltrating ductal carcinoma.
ObjectiveTo summarize the characteristics of cervical lymph node metastasis (LNM) in the papillary thyroid carcinoma (PTC) coexisting with Hashimoto thyroiditis (HT). MethodThe literatures related to cervical LNM of PTC coexisting with HT in recent years were collected and summarized. ResultsCompared with the PTC patients without HT, the more enlarged lymph nodes could be detected, and the cervival central LNM rate was lower, but there was still controversy about cervival lateral LNM in the patients with PTC coexisting with HT. The male, young, large tumor diameter, extraglandular invasion, multifocal cancer, BRAF gene mutation, and higher thyroid peroxidase antibody and thyroglobulin antibody levels, as well as the ultrasound features such as thyroid nodule aspect ratio >1, extremely low echo, calcification, and lymph node calcification, liquefaction, and disappearance of hilar lymph nodes could be used to evaluate the risk factors of cervical LNM for the patients with PTC coexisting with HT. ConclusionsFrom the results of this review, it is suggests that the rate of central LNM is lower in patients with PTC coexisting with HT, but the status of LNM in the cervical lateral region remains to be explored. The relevant risk factors in combination with ultrasonic characteristics could help evaluate cervical lymph node status, could provide basis for early detection of metastatic lymph nodes and the formulation of individualized surgical plans, and improve the prognosis of patients.
ObjectiveTo analyze the expression and significance of NF-κBp65 and autophagy-related proteins Beclin1 and p62 in patients with papillary thyroid carcinoma (PTC).MethodsOne hundred and sixty cases of PTC patients' tumor tissue specimens and paracancerous tissue specimens in our hospital from March 2013 to February 2015 were collected, and 90 cases of cervical lymph node metastasis tissue specimens of the above patients were collected. The expressions of NF-κBp65, Beclin1 and p62 in PTC tissues, metastatic lymph node tissues and paracancerous tissues were detected by immunohistochemical method, and the relationship between the above indexes and the clinicopathological characteristics and prognosis of PTC patients was analyzed.ResultsThe positive rates of expression of NF-kappa Bp65 and p62 in PTC tissues and metastatic lymph node tissues were higher than those in paracancerous tissues (P<0.05). The expression rate of Beclin1 in PTC tissues and metastatic lymph node tissues was lower than that in paracancerous tissues (P<0.05). The positive rate of NF-κBp65 expression in PTC tissues was not related to the clinicopathological characteristics of patients (P>0.05). The expression of p62 decreased with the increase of tumor differentiation (P<0.05). The expression of Beclin1 in patients with stage Ⅲ+Ⅳ and lymph node metastasis were lower than those in patients with stage Ⅰ+Ⅱ and without lymph node metastasis (P<0.05), while the expression of p62 was opposite. Spearman correlation analysis showed that the expression of Beclin1 and p62 in PTC tissues was negatively correlated (r=–0.656, P<0.01). In metastatic lymph node tissues, the expression of Beclin1 and p62 was also negatively correlated (r=–0.562, P<0.01). The 3-year survival rates of patients with positive expression of p62 and NF-κBp65 in PTC tissues were lower than that of patients with negative expression (P<0.05). The 3-year survival rate of patients with positive expression of Becrin1 was higher than that of negative expression (P<0.05). TNM stage, lymph node metastasis, NF-κBp65 and p62 were independent risk factors for PTC prognosis, and Beclin1 was protective factor.ConclusionsNF-κBp65 and p62 are highly expressed in PTC tissues and lymph node metastasis tissues, while Beclin1 is poorly expressed, which could be used as independent prognostic factors for PTC patients. In addition, Beclin1 and p62 are related to PTC biological behavior and may become potential indicators for PTC diagnosis.
Objective To explore the influencing factors of lymph node metastasis of Siewert Ⅱ/Ⅲ gastroesophageal junction adenocarcinoma (AEG) and its influence on prognosis of this kind of patients. Methods The clinical and pathological data of 49 patients with Siewert Ⅱ/Ⅲ AEG who admitted to Shiyan Hospital of Traditional Chinese from January 2010 to January 2013 were retrospectively analyzed. Univariate and multivariate analyses of factors affecting lymph node metastasis of AEG were performed by using a chi-square test and an unconditional logistic regression model; the effect of lymph node metastasis on the prognosis of patients with Siewert Ⅱ/Ⅲ AEG was performed by log-rank test. Results Multivariate unconditional logistic regression analysis showed that, tumor diameter (P=0.008), depth of invasion (P=0.019), vascular tumor thrombus (P=0.020), and degree of differentiation (P=0.017) were all influencing factors of lymph node metastasis. Patients with Siewert Ⅱ/Ⅲ AGE without lymph node metastasis had better survival than those with lymph node metastasis (P=0.005). Conclusion Tumor diameter, depth of invasion, degree of differentiation, and vascular tumor thrombus are independent risk factors for lymph node metastasis in patients with Siewert Ⅱ/Ⅲ AEG, and lymph node metastasis is associated with poor prognosis.
ObjectiveTo investigate the role of intraoperative frozen section pathology in central lymph node metastasis of papillary thyroid microcarcinoma (PTMC), and to analyze the risk factors of central lymph node metastasis.MethodsClinical data of 481 patients diagnosed with PTMC from January 2015 to June 2019 in our hospital were included. The consistency of frozen pathological results of intraoperative prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes with postoperative paraffin pathological results, as well as the relationship between the numbers of intraoperative lymph nodes sent for examination and postoperative pathological results were analyzed. Then the Kappa value were calculated respectively. Furthermore, univariate and multivariate analysis were used to analyze the factors affecting central lymph node metastasis.ResultsCentral lymph node metastasis was found in 207 patients with PTMC (43.0%). Of the 207 patients, 192 patients were examined by frozen section, with 139 patients had positive results. The Kappa value of prelaryngeal lymph nodes, paratracheal lymph nodes, pretracheal lymph nodes, and central lymph nodes were 0.300, 0.643, 0.560, and 0.755, respectively (P<0.001). Simultaneous intraoperative examination of three anatomic lymph nodes in the central region has a high accuracy in evaluating whether there was lymph node metastasis. The consistency test between intraoperative frozen and postoperative paraffin pathological results showed that when the number of lymph nodes was less than 5, the Kappa value was 0.690 (P<0.001), and when more than or equal to 5, the Kappa value was 0.816 (P<0.001). The results of logistic regression showed that, maximum value of tumor diameter, tumor number, and thyroid capsule involvement were risk factors for central region lymph node metastasis in PTMC (P<0.05).ConclusionsCentral region lymph node metastasis in PTMC was common. Prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes should be selected for frozen pathological examination during the operation, which could effectively indicate whether the central lymph nodes were involved. And combined with the risk factors of lymph node metastasis, such as maximum value of tumor diameter, number of tumors, and thyroid capsule involvement, a more accurate individualized operation plan can be designed for patients.
Objective To investigate the relationship between clinical features and lymph node metastasis in lung adenocarcinoma patients with T1 stage. Methods We retrospectively analyzed the clinical data of 253 T1-stage lung adenocarcinoma patients (92 males and 161 females at an average age of 59.45±9.36 years), who received lobectomy and systemic lymph node dissection in the Second Affiliated Hospital of Harbin Medical University from October 2013 to February 2016. Results Lymph node metastasis was negative in 182 patients (71.9%) and positive in 71 (28.1%). Poor differentiation (OR=6.988, P=0.001), moderate differentiation (OR=3.589, P=0.008), micropapillary type (OR=24.000, P<0.001), solid type (OR=5.080, P=0.048), pleural invasion (OR=2.347, P=0.024), age≤53.5 years (OR=2.594, P=0.020) were independent risk factors for lymph node metastasis. In addition, in the tumor with diameter≥1.55 cm (OR=0.615, P=0.183), although the cut-off value of 1.55 cm had no significant difference, it still suggested that tumor diameter was an important risk factor of lymph node metastasis. Conclusion In lung adenocarcinoma with T1 stage, the large tumor diameter, the low degree of differentiation, the high ratio of consolidation, and the micropapillary or solid pathological subtypes are more prone to have lymph node metastasis.
ObjectiveTo investigate the metastatic status and risk factors of axillary non-sentinel lymph node (NSLN) in breast cancer patients with 1–2 positive sentinel lymph nodes (SLN), and to provide theoretical basis for exemption of axillary lymph node dissection (ALND) in these patients. Methods A retrospective analysis was performed on 54 patients diagnosed with breast cancer who underwent sentinel lymph node biopsy (SLNB) and confirmed to have 1–2 positive sentinel lymph nodes (SLNS) and received ALND in the Department of Thyroid and Breast Surgery of Tongling People’s Hospital from January 2018 to April 2023. The patients were divided into NSLN metastatic group (17 cases) and NSLN non-metastatic group (37 cases) according to whether there was metastasis. Chi-square test was used to compare the basic information and clinicpathological features of the two groups. The independent risk factors for axillary NSLN metastasis were screened out by multivariate binary logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of independent risk factors combined with axillary NSLN metastasis. Results There were 54 cases with 1–2 metastasis of SLN, 17 cases with axillary NSLN metastasis (31.5%). The incidence of axillary NSLN metastasis in patients with tumor at T1 stage (maximum diameter ≤2 cm) was only 14.3% (4/28), however, the metastatic rate of axillary NSLN in patients with tumor in T2–T3 stage (maximum diameter >2 cm) was as high as 50.0% (13/26). The axillary NSLN metastasis rate was only 21.2% (7/33) with 1 SLN metastasis, while the axillary NSLN metastasis rate was 47.6% (10/21) with 2 SLN metastasis. Univariate analysis showed that T stage (tumor diameter >2 cm), 2 SLN metastases, number of SLN >5 and tumor with vascular embolus were more likely to develop axillary NSLN metastases (P<0.05). Multivariate binary logistic regression analysis showed that T stage (tumor diameter >2 cm) and 2 SLN metastases were independent risk factors for axillary NSLN metastasis in breast cancer patients, the area under ROC curve of combined prediction of axillary NSLN metastasis by the two was 0.747, 95%CI was (0.657, 0.917), sensitivity was 0.765 and specificity was 0.649. Conclusions The combination of tumor T stage and the number of SLN metastases can better predict axillary NSLN metastasis in breast cancer patients. ALND is recommended for breast cancer patients with T stage (tumor diameter >2 cm) and 2 SLN metastases to reduce the risk of residual axillary NSLN metastasis.
ObjectiveTo explore the value on excision of subpyloric (No.6 group) lymph nodes of stomach by detection of metastatic rate and metastasis of lymph nodes of No.6 group and its subgroups. MethodsThe clinical data including complete information on No.6 group and its subgroups lymph nodes in 80 patients underwent gastrectomy and subpyloric lymph nodes dissection for gastric cancer from January 2006 to December 2009 were retrospectively analyzed. Referring to the right gastroepiploic vein, the No.6 lymph nodes were divided into three subgroups (No.6a, No.6b, and No.6c subgroup), and the relationship between the metastasis of No.6 lymph nodes and clinicopathologic features as well as the metastasis of No.7, No.8a， and No.9 lymph nodes were analyzed by logistic regression analysis. ResultsThe metastatic rate of No.6 group lymph nodes was 41.3% (33/80) and with 26.0% (108/415) of the resected lymph nodes involved. The metastatic rate of lymph nodes in No.6a subgroup (7.5%, 6/80) was significantly lower than that in No.6b (16.3%, 13/80) and No.6c subgroup (36.3%, 29/80), Plt;0.001. The metastasis of the resected lymph nodes in No.6a, No.6b, and No.6c subgroup was 25.0% (8/32), 17.6% (13/74), and 28.2% (87/309), respectively, and the difference was not significant (P=0.292). The metastasis of lymph nodes in No.6a subgroup was correlated to T stage (P=0.042) and N stage (P=0.006). The metastasis of lymph nodes in No.6b subgroup was correlated to N stage (P=0.002) and TNM stage (P=0.013). The metastasis of lymph nodes in No.6c subgroup was correlated to differentiation degree of tumor (P=0.008), T stage (P=0.003), N stage (P=0.000), and TNM stage (P=0.000). The logistic regression analysis showed that the metastasis of lymph nodes was correlated to the metastasis of No.8a lymph nodes (P=0.023) and N stage (P=0.002) in No.6 group, the metastasis of No.8a lymph nodes (P=0.018) in No.6a subgroup, N stage (P=0.005) in No.6b subgroup, and the metastasis of No.8a lymph nodes (P=0.016) and N stage (P=0.004) in No.6c subgroup. ConclusionAttentions should be paid to the complete dissection of subpyloric lymph nodes in gastric cancer surgery, especially for the lymph nodes of No.6a and No.6b subgroups.