Abstract： Objective To analyze the modes and rules of subcarinal lymph node metastasis in non-small cell lung cancer patients， and explore appropriate surgical dissection strategy of subcarinal lymph nodes for patients with non-small cell lung cancer. Methods The clinical data of 608 patients with non-small cell lung cancer who underwent lung resection and systematic lymph node dissection in Henan Cancer Hospital from September 2002 to October 2011 were analyzed retrospectively. There were 388 males and 220 females with an average age of 62.3 （45-78） years. There were 122 patients with left upper lobe tumor， 119 patients with left lower lobe tumor， 158 patients with right upper lobe tumor， 40 patients with right middle lobe tumor and 169 patients with right lower lobe tumor. Subcarinal lymph node metastasis was observed in 118 patients （19.4%）. There were 244 patients with squamous carcinoma， 285 patients with adenocarcinoma and 79 patients with other types of carcinoma. The relationship of subcarinal lymph node metastasis with tumor location， pathological types and clinicopathological characteristics were analyzed. Results There was statistical difference in subcarinal lymph node metastasis rate among different tumor locations （P=0.000）. Subcarinal lymph node metastasis rate was the highest ［45.8% （54/118）］ in patients with right lower lobe tumor. For patients with different pathological types， subcarinal lymph node metastasis rate was the highest ［55.9% （66/118）］ in patients with adenocarcinoma， and then squamous carcinoma （P=0.034）. Subcarinal lymph node metastasis rate increased with the increase in T staging， and patients with tumors located in the middle or lower lobe of the left or right lung had a significantly higher subcarinal lymph node metastasis rate than patients with upper lobe tumor. Conclusion Subcarinal lymph node metastasis rate are lower in patients with left or right upper lobe tumor， patients with squamous carcinoma whose clinical T staging is within cT 1 .
ObjectiveTo analyze the characteristics and risk factors of lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC).MethodsThe clinical data of 407 patients with ESCC who underwent radical resection of esophageal carcinoma from December 2012 to October 2018 in our hospital were retrospectively analyzed. There were 390 males and 17 females with a median age of 63 (38-82) years. Esophageal lesions were found in 26 patients of upper thoracic segment, 190 patients of middle thoracic segment and 191 patients of lower thoracic segment. ResultsAmong the patients, 232 (57.0%) were found to have cervical, thoracic and/or abdominal lymph node metastasis. The lymphatic metastasis rates of cervical, upper, middle, lower mediastinal nodes and abdominal nodes were 0.7%, 8.8%, 21.4%, 16.7% and 37.1%, respectively. The adjacent lymph node metastasis alone occurred in 50.0% patients, and the multistage or skip lymph node metastasis accounted for 29.3% and 20.7%, respectively. Multivariate analysis showed that the length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion were independent risk factors for lymph node metastasis.ConclusionThe rates of lymph node metastasis are similar in the upper, middle and lower thoracic ESCC. The main pattern of lymph node metastasis is the adjacent lymph node metastasis, followed by multistage and skip lymph node metastases. The length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion are independent factors for lymph node metastasis. The operation and dissection range should be selected according to the location of tumor and the characteristics of the lesion.
ObjectiveTo investigate the diagnostic value and the best criteria of multiplanar reconstruction (MPR) of spiral CT in recurrent laryngeal nerve lymph node metastasis.MethodsWe performed multiplanar reconstruction of the spiral CT data of 138 esophageal carcinoma patients admitted to our hospital between December 2016 and June 2019, including 113 males and 25 females with an average age of 47-85 (63.03±15.58) years. The short and long diameters of recurrent laryngeal nerve lymph nodes were measured respectively, and then ratio of short to long diameter was calculated. The three parameters were contrasted with the pathological results and the receiver operating characteristic (ROC) curves for the parameters were drawn.ResultsOf the 138 patients, 291 left recurrent laryngeal nerve lymph nodes were dissected with an average number of 0-14 (2.11±0.41) per patient and the metastasis rate was 16.70%; while 436 right ones were dissected with the average number of 0-17 (3.16±0.45) per patient and the metastasis rate was 21.00%. The total metastasis rate was 29.70%. In the diagnosis of lymph node metastasis, the areas under ROC curve for short and long diameters as well as the ratio of short to long diameter of left recurrent laryngeal nerve lymph nodes were 0.808, 0.779, 0.621, respectively, while those for the right ones were 0.865, 0.807, 0.637, respectively.ConclusionThe metastasis rate of recurrent laryngeal nerve lymph nodes is high and the short diameter has a higher diagnostic value for recurrent laryngeal nerve lymph node metastasis.
Objective To explore the relationship between pure solid non-small cell lung cancer with diameter<2 cm and lymph node metastasis rate. Methods We retrospectively analyzed clinicopathological data of 611 patients who underwent lobectomy and systematic lymph node dissection in our hospital between October 2005 and September 2016. There were 322 males and 289 females aged 58.8±10.0 years (range from 25 to 84 years). The relationship between clinicopathological feature and lymph node metastasis rate was analyzed by logistic regression. Results Lymph node metastasis was observed in 136 patients. The rate of lymph node metastasis was 22.3% in pure solid non-small cell lung cancer with diameter<2 cm. The result of univariate analysis showed that differentiation of tumor (P<0.001), location of tumor (P=0.047) and gender (P=0.032) were associated with lymph node metastasis. Multivariate analysis showed that differentiation of tumor was an independent risk factor for lymph node metastasis (P<0.001). Conclusion The rate of lymph node metastasis is high in pure solid non-small cell lung cancer with diameter<2 cm. Differentiation of tumor is an independent risk factor for lymph node metastasis. We recommend systematic lymph node dissection in the patients of this group. And we should choose sublobar resection prudentially.
ObjectiveTo explore the risk factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC), and try to establish a risk prediction model for LNM of EGC.MethodsThe clinicopathologic data of EGC patients who underwent radical gastrectomy and lymph node dissection from January 1, 2015 to December 31, 2019 in this hospital were retrospectively analyzed. Univariate analysis and logistic regression analysis were used to determine the risk factors for LNM of EGC, and the risk prediction model for LNM of EGC was established based on the multivariate results.ResultsA total of 311 cases of EGC were included in this study, and 60 (19.3%) cases had LNM. Univariate and multivariate analysis showed that age (younger), depth of tumor invasion (submucosa), vascular invasion, and undifferentiated carcinoma were the risk factors for LNM of EGC (P<0.05). The optimal threshold for predicting LNM of EGC was 0.158 (area under the receiver operating characteristic curve was 0.864), the sensitivity was 80.0%, and the specificity was 79.3%.ConclusionsFrom results of this study, risk factors for LNM of EGC have age, depth of invasion, vascular invasion, and differentiation degree. Risk prediction model for LNM of EGC established on this results has high sensitivity and specificity, which could provide some references for treatment strategy of EGC.
Objective To summarize the influencing factors of central lymph node metastasis in thyroid papillary carcinoma. Method Relevant literature about papillary thyroid carcinoma were reviewed and predictive factors of central lymph node metastasis were summarized. Results Studies had shown that, male, younger age, larger tumor size, multifocal, and BRAF mutations were risk factors for central lymph node metastasis in thyroid papillary carcinoma, while tumors located in the upper pole and combined with Hashimoto disease (HT) were the protective factors for central lymph node metastasis. Conclusions The central lymph node metastasis detection rate is low, so it is unable to meet with the preoperative diagnosis in papillary thyroid carcinoma. A large number of studies have confirmed that clinical pathological features have predictive value for preoperative lymph node diagnosis, and can provide a reference for the selection of surgical methods in thyroid papillary carcinoma.
Objective To explore regularity of lymph node metastasis and analyze its relation between lymph node metastasis and histological features and its immunohistochemical markers of gastric cancer, and to provide evidence for selection of reasonable operation. Method The clinical data of 160 patients with gastric cancer who underwent D2, D3 or D3+ from August 2013 to May 2016 in the Second Hospital of Lanzhou University were retrospectively studied, and the relation between the lymph node metastasis and the pathological features and the immunohistochemical markers in the different location of gastric cancer was analyzed. Results ① The rate of lymph node metastasis in the early gastric cancer was significantly lower than that in the advanced gastric cancer (P<0.05), which in the T4 stage was significantly higher than that in the T1–T3 stages (P<0.05), in the poorly differentiated gastric cancer was significantly higher than that in the well differentiated gastric cancer (P<0.05), or in the Borrmann type Ⅲ+Ⅳ (infiltrative type) was significantly higher than that in the Borrmann type Ⅰ+Ⅱ (topical type,P<0.05), but which wasn’t associated with the gender, tumor location, or tumor diameter (P>0.05). ② The lymph node metastasis occurred mainly in the first and the second stations for the well differentiated gastric cardia cancer, which not only occurred in the first and the second stations, but also occurred in the No.13 lymph node for the poorly differentiated gastric cardia cancer; which occurred mainly in the first and the second stations and occasionally occurred in the No.12 lymph node for the well differentiated gastric body cancer, which not only occurred in the first and the second stations, but also occurred in the No.12, No.13 and No.14 lymph nodes for the poorly differentiated gastric body cancer; which occurred in the No.11, No.12 and No.13 lymph nodes for the part of well differentiated gastric antrum cancer, which even occurred in the No.15 and No.16 lymph nodes for the part of poorly differentiated gastric antrum cancer. ③ The expression positive rates of the TopoⅡα, Villin, Ki-67, CK-8, and CK-18 proteins in the poorly differentiated gastric cancer were significantly higher than those in the well differentiated gastric cancer (P<0.05), which of the P-gp, GST-π, and c-erbB-2 proteins in the poorly differentiated gastric cancer were significantly lower than those in the well differentiated gastric cancer (P<0.05). The expression positive rates of the TopoⅡα, P-gp, Villin, Ki-67, CK-8, and CK-18 proteins in the gastric cancer with lymph node metastasis were significantly higher than those in the gastric cancer without lymph node metastasis (P<0.05), whereas there were no relation between the expression positive rates of the GST-π and c-erbB-2 proteins and the lymph node metastasis of gastric cancer (P>0.05). ④ The different location of gastric cancer wasn’t associated with the gender, gross type, clinical stage, T stage, degree of differentiation, Borrmann type, or tumor diameter. Conclusions In advanced gastric cancer, depth of tumor invasion reached T4, poor degree of differentiation, and Borrmann infiltration type of gastric cancer, lymph node metastasis rates are higher. For gastric cardia cancer patients with well differentiation, standard D2 should be performed, D2+No.13 should be performed for poor differentiation. For gastric body cancer patients with well differentiation, D2+No.12 should be performed, D3 should be performed for poor differentiation. For gastric antrum cancer patients with differentiation degree or not, D3 should be performed, selective dissection of No.15 or No.16 lymph node should be performed for poor differentiation. Combined detection of TopoⅡα, Villin, Ki-67, CK-8, CK-18, P-gp, GST-π, and c-erbB-2 immunohistochemical markers might be helpful to improve accuracy of lymph node metastasis and evaluate degree of malignancy and prognosis of patients with gastric cancer.
ObjectiveTo summarize the complications after supraclavicular lymph node dissection for invasive breast cancer patients with ipsilateral supraclavicular lymph node metastasis but without distant metastasis, and to analyze its safty. MethodsA retrospectively clinical analysis of the complications of 98 invasive breast cancer patients with ipsilateral supraclavicular lymph node metastasis but without distant metastasis, who underwent supraclavicular lymph node dissection in our hospital from Jan. 2014 to Dec. 2015 was performed. ResultsThere were 20 cases of lymphedema (20.4%, 20/98), 4 cases of hypaesthesia (4.1%, 4/98), and 4 cases of abduction restriction of shoulder joint (4.1%, 4/98). No other serious complications occurred. There was no shape change of shoulder and upper arm abduction, facial edema, head and neck disorders, pleural effusion or chylothorax happened. The extubation time of drainage tube at axillary and chest wall in 78 cases was in 1 month after the operation, 18 cases was in 1-2 months, and 2 cases was in 2-3 months. There were 14 cases (14.3%) suffered from the ipsilateral axillary or pleural effusion after extubation. The extubation time of supraclavicular drainage tube in 98 cases was 3-7 days after the surgery, with the median of 4.5 days, including 3 cases (3.1%) of chyle leakage. ConclusionThe supraclavicular lymph node dissection has no serious postoperative complications, and is safe to patients with ipsilateral supraclavicular lymph node metastasis but without distant metastasis.
ObjectiveTo analyze rate of intraperitoneal lymph node metastasis (LNM) in Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction (AEG) so as to determine optimal extent of lymph node dissection. MethodsA systematic and comprehensive search of PubMed, Medline, and Cochrane Library databases for study reports on LNM in patients with Siewert type Ⅱ/Ⅲ AEG was performed. The retrieval time ranged from database establishment to October 1, 2021. The pooled LNM rate was analyzed for each lymph node group. In addition, the influencing factors of LNM in AEG were analyzed. ResultsAfter screening, a total of 22 relevant studies were included, with a total of 3 934 cases. For the patients with Siewert type Ⅱ/Ⅲ AEG, the LNM rates of No.1, 2, 1&2, 3, 7 lymph nodes were ≥20%, LNM rates of No.4, 9, 11 (11p+11d), 11p, 16 lymph nodes were 10%–20%, LNM rates of No.4sa, 8a, 10, 11d lymph nodes were 5%–10%, the rest were <5%. For the patients with Siewert type Ⅱ AEG, the LNM rates of No.1, 2, 1&2, 3, 7 lymph nodes were ≥20%, LNM rates of No.4, 9, 11 (11p+11d), 11p lymph nodes were 10%–20%, LNM rates of No.8a, 10 lymph nodes were 5%–10%, and the rest were <5%. For the patients with Siewert type Ⅲ AEG, the LNM rates of No.1, 2, 1&2, 3, 4, 7 lymph nodes were ≥20%, LNM rate of No.11p lymph nodes was 10%–20%, LNM rates of No.4sa, 4sb, 4d, 8a, 9, 10, 11(11p+11d), 11d lymph nodes were 5%–10%, and the rest were <5%. No matter Siewert Ⅱ and (or) Ⅲ AEG patients, the rates of LNM in No.5, 6, and 12a lymph nodes were <5%. The tumor diameter ≥2 cm and higher T stage (T2–T4) increased the probability of LNM in AEG (P<0.05). ConclusionsThe results of this meta-analysis combined with the literature suggest that in clinical practice, No.10 lymph node dissection is not necessary for Siewert Ⅱ and Siewert Ⅲ AEG patients with tumor length diameter <2 cm and T1 of tumor invasion. No matter Siewert Ⅱ or Ⅲ AEG, as long as the tumor length diameter <2 cm and T1 of tumor invasion, the distal perigastric lymph nodes (No.4d, 5, 6) may not be dissected; Siewert type Ⅱ or Ⅲ AEG patients don’t need to clean No.12a lymph nodes.
Objective To investigate the efficacy of fine needle aspiration-thyroglobulin (FNA-Tg) with colloidal gold immunochromatographic assay (CGICA) on the assessment of lymph node metastasis during surgery in papillary thyroid carcinoma (PTC) patients. Methods Seventy-eight patients with PTC who underwent surgery in the Department of Thyroid Surgery of West China Hospital of Sichuan University from August to December 2019 were selected as the research objects, 289 neck lymph node specimens cleaned during the operation were prepared into eluent after lymph node FNA within 10 minutes in vitro, and then the FNA-Tg level was detected rapidly and quantitatively by CGICA. The specimen of washout fluid was labeled and sent to the laboratory for FNA-Tg detection by Roche electrochemiluminescence immunoassay. The lymph nodes in the whole group were divided into central region group and lateral cervical region group according to their location. According to the long diameter of lymph nodes, they were divided into <5 mm group, 5–10 mm group and >10 mm group. With postoperative pathological report as the gold standard, the receiver operating characteristic (ROC) curve of the whole group of data subjects was drawn, and the area under curve (AUC) was compared to calculate the best cut-off value of FNA-Tg in diagnosing PTC lymph node metastasis. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of FNA-Tg CGICA method and Roche method in the whole group and different subgroups were compared. The data of 55 lymph nodes detected by FNA-Tg CGICA method and rapid frozen pathology were collected, and the diagnostic efficacy indexes of CGICA method and rapid frozen pathology in the diagnosis of lymph node metastasis were compared. Results The ROC curves AUC of FNA-Tg detected by CGICA method and Roche method was 0.850 and 0.883, respectively, the difference was not statistically significant (Z=1.011, P>0.05). The sensitivity was 77.7% and 79.6% respectively (χ2=0.05, P>0.05), specificity was 84.9% and 93.5% respectively (χ2=7.50, P<0.05). Using McNemar test, there was no significant difference in the diagnostic results between the CGICA method and Roche method of FNA-Tg in the whole group (P>0.05). The diagnostic efficacy of FNA-Tg CGICA method was better in the lateral cervical region group than that in the central region group, and the diagnostic efficacy of the group with the long diameter of lymph nodes >10 mm was better than those of the groups with the long diameter of lymph nodes <5 mm and 5–10 mm. There was no significant difference in diagnostic results between FNA-Tg CGICA method and rapid frozen pathology (P>0.05). Conclusions The FNA-Tg CGICA method has high value in diagnosing PTC cervical lymph node metastasis, and has the characteristics of rapidity and convenience. The diagnostic efficiency is similar to that of Roche method.