RELATIONSHIP BETWEEN LYMPH NODE METASTASES IN ESOPHAGEAL CARCINOMA AND ITS PROGNOSIS

Objective: To study the relationship between lymph node metastases in esophageal carcinoma and its prognosis. Methods: We obtained 1500 resected lymph nodes from the specimen of 86 patients with resected esophageal carcinoma and checked these lymph nodes by routine histopathology. Additiionally, frozen tissue sections of 540 lymph nodes classified as tumor-free by routine histopathology were screened for micrometastases by immunohistology with the monoclonal antibody Ber-EP4. Results: Forty-two patients (49%) had pN0 disease, and 61 patients (71%) had lymph node micrometastases detected by immunohistochemistry, skip metastases detected by routine histopathology were present in 26%(11/42) of pN0 and 41%(18/44) of pN1 patients. Skipping of micrometastases detected by immunohistochemistry was found in 71%(61/86). Twenty-six of 42 patients (62%) with tumor staged as pN0 and 35 of 44 patients (80%) with stage pN1 had nodal micrometastasis. The presence of micrometastases was associated with a significantly decreased relapse-free time and overall survival (P<0.0001 and P=0.004, respectively). Conclusion: Lymph node skip metastases are a frequent event in esophageal carcinoma. Extensive lymph node sampling, in conjunction with immunohistochemical detection, will lead to accurate staging and prognosis.

Surgical treatment and prognosis of octogenarians with non-small cell lung cancer

Objective:To explore the clinical characteristics,surgical treatment and prognosis of nonsmall cell lung cancer(NSCLC) among elderly patients over 80 years.Methods:The clinical data,surgical methods,perioperative management,postoperative complications and prognosis of 52 NSCLC patients aged over 80 years were retrospectively analyzed.Results:Out of 52 cases, 27 had a long-term smoking history(51.9%) and 44 were with other diseases(84.6%).Lobectomy was done in 32 cases(65.4%),sub-lobectomy in 20 cases(38.5%),including pulmonary wedge resection in 16 cases(30.8%) and lung segment resection in 4 cases(7.7%).The postoperative complication rate was 44.2%(23/52);the complication rate after lobectomy was 62.5%(20/32) and that after sub-lobectomy was 25%(5/20),with significant difference between lobectomy and sublobectomy (P【0.05).Postoperative mortality was 3.8%(2/52).Pathological TNM staging:Ⅰa 27 cases(51.9%),Ⅰb 12 cases(23.1%),Ⅱa 8 cases(15.4%),Ⅱb 3 cases(5.8%) andⅢ2 cases(3.8%). The 1-,3- and 5-year survival rate after operation was 87.1%,59.8%,19.1%.The 1-,3- and 5-year survival rate was 86.0%,61.8%,21.5%in the patients after lobectomy,that was 89.0%,58.3%, 18.7%in the patients after sub-lobectomy,with no significant difference between two surgical methods(P】0.05).Conclusions:Octogenarians with NSCLC are often afflicted with comorbidity, so perioperative management is more complex.Strictly adhering to indications,surgery is still an important treatment of NSCLC patients over 80.