Lymph node micrometastasis and its correlation with MMP-2 expression in gastric carcinoma

AIM： To examine matrix metalloproteinase-2 （MMP-2） expression in gastric cancer tissues and to evaluate its relationship with lymph node micrometastasis. MATERIALS： The authors studied 850 lymph nodes resected from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenetomy using reverse transcription polymerase chain reaction （RT-PCR） assay in addition to H-E staining. MMP-2 expression of the tumor tissues was detected by immunohistochemical technique （EliVision^TM plus）. RESULTS： MMP-2 expression was positive in 21 （70%） cases and negative in g （30%） cases. No significant correlations were found between MMP-2 expression and other variables such as age, gender, tumor location, tumor diameter, Lauren classification and lymphatic invasion. In contrast, MMP-2 expression correlated significantly with depth of tumor infiltration （P = 0.022）, lymph node metastasis （P = 0.030） and tumor differentiation （P = 0.043）. Lymph node micrometastases were detected in 77 （12.5%） lymph nodes of 14 （46.7%） gastric carcinoma patients. MMP-2 expression was positive in 12 （85.7%） of the 14 patients with lymph node micrometastasis, and in g （56.3%） of the 16 patients without lymph node micrometastasis （P = 0.118）. CONCLUSIONS： Our results demonstrate that MMP-2 expression has significant correlation with tumor invasion, tumor differentiation and lymph node metastases. MMP-2 expression may be an important biological characteristics and significant prognostic parameter of gastric carcinoma. We also conclude that MMP-2 may participate in the development of lymph node micrometastasis of gastric carcinoma. Further investigations are needed to draw a conclusion.

Expression of E-cadherin in gastric carcinoma and its correlation with lymph node micrometastasis

AIM: To examine the expression of E-cadherin in the primary tumor and to evaluate its relationship with lymph node micrometastasis (LNM).METHODS: The authors studied 850 lymph nodes resected from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenectomy using reverse transcription polymerase chain reaction (RT-PCR) assay in addition to H&E staining. Cytokeratin-20 (CK-20)gene marker was used in this assay. The level of E-cadherin expression in the primary tumor was examined by immunochemical technique (EliVisionTM plus).RESULTS: LNM was detected in 77 (12.5%) lymph nodes of 14 patients (46.7%) with gastric carcinoma. The incidence of LNM was significantly higher in the diffuse type (12 of 19 cases, 63.2%) than in the intestinal type of gastric carcinoma (2 of 11 cases, 18.2%, P = 0.026). The incidence of LNM also increased in accordance with the depth of tumor invasion. The loss of expression of E cadherin in primary tumors was found in 14 (46.7) of 30 tumors. The absence of E-cadherin expression was significantly associated with the Lauren classification (P = 0.026), lymph node metastasis (P = 0.011), the grade of differentiation (P = 0.004) and the lymphatic invasion (P = 0.001). Expression of E-cadherin was negative in 10 (71.4%) of the 14 patients with LNM, and in 4 (25%) of the 16 patients without LNM (P = 0.026). CONCLUSION: The current results indicate that the RT PCR assay is useful for the detection of LNM and can significantly increase the detection rate of lymph node metastasis in patients with gastric carcinoma. The Laurenclassification and depth of tumor invasion are significantlyassociated with lymph node micrometastases. Our findings also indicate that E-cadherin may play an important role in determining the growth type and differentiation of gastric carcinoma. The loss of E-cadherin expression may contribute to LNM.

Detection of micrometastasis in peripheral blood by multi-sampling in patients with colorectal cancer

AIM: To evaluate the reverse transcriptase-PCR assay and multiple sampling for detection of cytokeratin-positive cells in peripheral blood of colorectal carcinoma patients and to investigate the clinical significance of micrometastasis in peripheral blood.METHODS: The expression of CK20 mRNA by RT-PCR was investigated in bone marrow, portal vein and peripheral blood in 58 colorectal cancer patients and 12 controls without known cancer. The peripheral blood was sampled twice at intervals of 3 d before operation. All the patients were followed up for one year.RESULTS: There was no positive expression of CK20mRNA in 12 volunteers. The positive expression of CK20mRNA was 77.6% (45/58) in bone marrow, and that in portal vein was 74.1% (43/58) of colorectal carcinoma patients.The positive expression of CK20mRNA cells in peripheral blood rose from 44.8% (26/58) to 69.0% (40/58) (P＜0.01).The total positivity of CK20mRNA expression in peripheral blood was similar to the positivity of CK20mRNA in bone marrow and portal vein. The positive rates became higher in later clinical stages than in early stages. The CK20mRNA positive patients had a higher relapse rate within one year than the CK20mRNA negative patients.CONCLUSION: Multiple blood sampling can increase the detection of tumor cells in peripheral blood by RT-PCR for CK20mRNA in colorectal carcinoma patients and it is as sensitive and specific as that of bone marrow and portal vein. This technique may be reliable and convenient to diagnose micrometastasis of colorectal carcinoma and has an important significance in determining the prognosis of cancer patients.

K-19 mRNA RT-PCR in detecting micrometastasis in regional lymph nodes of gastric cancer

AIM： To investigate the value and prospect of RT-PCR in detecting micrometastasis in regional lymph nodes of gastric cancer. METHODS： Histopathology was used and K19 mRNA expression was detected by RT-PCR in tumor tissues and lymph nodes from gastric cancer patients undergoing radical resection of gastric carcinoma. RESULTS： K19 mRNA was expressed in all tumor specimens of 30 cases; of the 126 lymph nodes, 26 were histopathologically positive （20.6%）, and 42 positive （33.3%） by RT-PCR. Amplification fragments of 460 and 540 bp were shown in all the tumor tissues and metastatic lymph nodes after K19 and β-actin RT-PCR, while only a 540 bp fragment appeared in the lymph nodes of non-tumor patients. CONCLUSION： K19 mRNA RT-PCR is sensitive and specific in testing micrometastasis in regional lymph nodes of gastric cancer, and it is superior to routine histopathology.

Impact of lymph node micrometastasis in hilar bile duct carcinoma patients

AIM- To immunohistochemicaUy examine micrometastasis and VEGF-C expression in hilar bile duct carcinoma （HBDC） and to evaluate the clinical significance of the results. METHODS： A total of 361 regional lymph nodes from 25 patients with node-negative HBDC were immunostained with an antibody against cytokeratins 8 and 18 （CAM 5.2）, and immunohistochemical staining of VEGF-C was performed in 34 primary resected tumors. RESULTS： Lymph node micrometastasis was detected in 6 （24%） of the 25 patients and 10 （2.8%） of the 361 lymph nodes. Patients with micrometastasis showed significantly poorer survival rates than those without （P= 0.025）. VEGF-C expression was positive in 17 （50%） of 34 HBDC, and significantly correlated with lymph node metastasis （P=0.042） and microscopic venous invasion （P=0.035）. CONCLUSIONS： It is suggested that immunohistochemically detected lymph node micrometastasis has an impact on the outcome of HBDC. VEGF-C expression is highly correlated with lymph node metastasis in HBDC and might therefore be a useful predictor.

Clinical significance of molecular diagnosis for gastric cancer lymph node micrometastasis

Advances in molecular diagnostic tools have allowed the identification of lymph node micrometastasis(LNM),including isolated tumor cells,in cancer patients. While immunohistochemistry and reverse transcription-polymerase chain reaction have been used to identify LNM in patients with gastric cancer,the clinical significance of this finding remains unclear. Recently,minimally invasive treatments,such as endoscopic submucosal dissection and laparoscopic surgery,are widely performed to help improve postsurgical quality of life(QOL). However,it is important to maintain the balance between QOL and curability when making treatments decision for patients with gastric cancer. If minimally invasive surgery based on accurate intraoperative LNM diagnosis was established,it could be performed safely. Therefore,we reviewed the clinical significance of LNM detected by molecular techniques as an important target for treatment decision making with gastric cancer patients.

Serum Vascular Endothelial Growth Factor Levels in Patients with Non-small Cell Lung Cancer and Its Relations to the Micrometastasis in Peripheral Blood

To examine the relationship between the levels of the serum vascular endothelial growth factor （VEGF） and the micrometastasis of peripheral blood in patients with non-small cell lung cancer （NSCLC）, 108 NSCLC patients, including 40 patients with benign lung diseases and 30 healthy controls, were investigated. The serum VEGF levels were detected by ELISA and CK19 mRNA in peripheral blood by reverse transcriptase-polymerase chain reaction （RT-PCR）. In NSCLC group, the serum VEGF levels and the positive rate of CK19 mRNA in peripheral blood were 479.8±268.5 pg/mL and 66.7%, which were significantly higher than those of the other two groups respectively （P〈0.01）, and both of them were increased significantly with the progression of clinical stage of the tumors （P〈0.01）. Serum VEGF levels as well as the positive rate of CK19 mRNA in different pathological types of lung cancer had no significant differences （P〉0.05）. Serum VEGF levels in the patients positive for CK19 mRNA was 561.7±325.6 pg/mL. It is significantly higher than that in the negative patients （P〈0.01）. There existed a significant correlation between serum VEGF levels and expression of CK19 mRNA in peripheral blood in NSCLC patients （P〈0.001）. The detection of serum VEGF levels and CK19 mRNA in peripheral blood is helpful in judging the condition and the prognosis of NSCLC patients, and serum VEGF levels and CK19 mRNA are independent of the pathological types of lung cancer. The micrometastasis in peripheral blood of NSCLC patients is significantly associated with serum VEGF levels.

Multimarker Detection of MAGE-1,MAGE-3 and AFP mRNAs by a Real-time Quantitative PCR Assay:a Possible Predictor of Hematogenous Micrometastasis of Hepatocellular Carcinoma

OBJECTIVE To explore the relationship between multimarker detection of MAGE-1,MAGE-3 and AFP mRNAs in the peripheral blood of patients with hepatocellular carcinoma and micrometastasis using a realtime quantitative-PCR(real-time Q-PCR)assay. METHODS Peripheral blood samples were obtained from control subjects and 86 patients with hepatocellular carcinoma (HCC).Real-time Q-PCR was used to detect MAGE-1,MAGE-3, and AFP mRNAs in the blood cells. RESULTS In 86 tumor specimens,the positivity for MAGE-1, MAGE-3,and AFP genes was respectively 34.9%(30/86),60.5% (52/86)and 69.8%(60/86).All specimens expressed at least one marker.MAGE-1,MAGE-3,and AFP transcripts were detected respectively in 12(14.0%),18(20.1%)and 29(33.7%)of the 86 blood specimens from hepatocellular carcinoma patients,while 45 specimens(52.3%)were positive for at least one marker.In addition,MAGE-1,MAGE-3 and AFP gene transcripts were not detected in any peripheral blood specimens from 25 chronic liver disease patients and 28 normal healthy volunteers.The positive rate correlated with the TNM clinical stages,extrahepatic metastasis and portal vein carcinothrombosis(P<0.05).No correlation was found between tumor size,tumor number, differentiation,serum a-fetoprotein(AFP)and the positive rate. CONCLUSION Our results indicate that a multimarker real- time Q-PCR assay with cancer-specific markers such as MAGE-1 and MAGE-3 in combination with a hepatocyte-specific AFP marker may be a promising diagnostic tool for monitoring hepatocellular carcinoma patients with better sensitivity and specificity.

Effect of immune function on lymph node micrometastasis in esophageal cancer patients

Objective: To explore the effect of immune function on lymph node micrometastasis in esophageal cancer patients by the research on the correlation between immune function and micrometastasis. Methods: Ratios of T-lymphocyte subsets CD3+, CD4+, CD8+ and CD4+/CD8+ in peripheral blood were examined by flow cytometry, but no lymph node with metastatic cancer cells was observed in middle thoracic esophageal squamous carcinoma patients by routine pathological examination. The patients were divided into 2 groups with or without micrometastasis to detect micrometastasis by immunohistochemical method, and T-lymphocyte subsets levels were compared between the 2 groups. Results: CD3+ and CD4+ T-lymphocytes levels of the group with micrometastasis were significantly lower than those of the group without micrometastasis, while CD8+ level of the group with micrometastasis was significantly higher than that of the group without micrometastasis. Conclusion: T-lymphocyte subset is closely relative with micrometastasis, and prognosis of the patients with low CD3+ and CD4+ levels but high CD8+ T-lymphocytes is comparatively poor.

Mapping of Sentinel Lymph Node Micrometastasis in Dukes-B Colorectal Carcinoma and Its Clinical Significance

OBJECTIVE To investigate the detection of sentinel lymphnode (SLN) micrometastasis (MM) and the clinical significancein patients with Dukes-B colorectal carcinoma (CRC) using H&Estained slides.METHODS In a prospective study of 64 patients with Dukes-BCRC undergoing radical surgery,routine H&E staining combinedwith the immunohistochemical SP method was used to detect theexpression of the cytokeratin 20 (CK20) and telomerase (TLMA)in 122 SLNs from 61 of the 64 cases.During a 3-year follow up,the patients'clinicopathologic parameters data,survival and theirrelationship were collected and analyzed.RESULTS i) In 6 out of the 61 cases with successful mapping,9SLNs were positive after routine detection using H&E staining.ii) In the other 55 with negative results from H&E staining,thepositive rate of CK20 expression was 27.3% (15/55),and thepositive rate of TLMA 21.8% (12/55),after immunohistochemicalexamination (IHC) on the SLN.iii) Detection by combining the 2methods showed that the micrometastasis rate was 38.2% (21/55).iv) The recurrence or metastasis rate of CRC was significantlyhigher in the Dukes-B patients with sentinel lymph nodemicrometastasis (SLNMM) (+) than in those with SLNMM (-)(P<0.05),and simultaneously,the survival rate decreased by alarge margin in the patients with SLNMM (+),compared to thosewith SLNMM (-) (P<0.05).There were significant differences inthe recurrence or metastasis rate of cancer and the survival ratebetween the Dukes-B patients with SLNMM (-) and the Dukes-Cpatients (P<0.05).CONCLUSION Examination of anti-CK20 and anti-TLMA usingimmunohistochemical staining can be used to detect SLNMM,andthe combined examination of the 2 can increase the detection rate.The detection of SLNMM can precisely determine the Dukes stageof colorectal carcinoma,which is of help in directing postoperativeadjunctive therapy and in assessing prognosis.

MUC2 mRNA detection in peripheral blood and bone marrow of breast cancer patients reveals micrometastasis

Tumor dissemination to distant organ is the main cause of death. Therefore there is urgent need to set up sensitive methods for early detection of circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) in peripheral blood (PB) and bone marrow (BM) specimens of breast cancer patients. We aim to detect MUC2 mRNA positive cells in PB and BM of breast cancer patients;to relate this to patient relapse. In this study to detect MUC2 mRNA positive cells (tumor marker), PB and BM samples were collected from 50 breast cancer patients after operation and before adjuvant therapy with 20 PB from healthy individuals as negative controls. Chi-square test was used to analyze data. MUC2 mRNA by using Real-time PCR was detected in 9 (18%) of PB and in 10 (20%) of BM samples and none of the healthy individuals. The relapse rate among MUC2-positive patients was significance in BM (P < 0.004) and MUC2-positive patients had a shorter disease free survival than the negative patients in BM samples (p < 0.05). This study shows MUC2 can be a suitable marker for detection of micrometastasis in breast cancer patients at early stages of cancer.

Influence of lymph node micrometastasis on the staging system for gastric cancer

Objective The aim of this study was to investigate the effect of lymph node micrometastasis on the prognosis of patients with gastric cancer and the necessity of integrating it into the gastric cancer staging system.Methods In total,241 patients with gastric cancer were included.Hematoxylin and eosin staining of lymph nodes was performed,and negative lymph nodes were evaluated by immunohistochemistry to detect micrometastases.Differences in survival rates between stages were evaluated.Results(1)A total of 78 patients(32.4%)had lymph node micrometastases.Compared with the group without micrometastases,the overall recurrence rate,lymph infiltration,vascular invasion,and nerve invasion rate in the micrometastasis group were significantly higher(P<0.05).(2)According to the standard N staging system,the rates of disease-free survival(DFS)for the N0,N1,N2,N3a,and N3b groups were 96.0%,84.0%,67.6%,59.0%,and 21.7%,respectively.There was no significant difference in survival between N2 and N3a.The cumulative survival curves for N2 and N3a intersected.(3)The N stage of 38 patients(15.8%)differed between the traditional system and the new N staging system reflecting micrometastasis.The DFS for N0,N1,N2,N3a,and N3b were 97.0%,86.3%,74.2%,65.4%,and 29.2%,respectively.There was no significant difference in survival between N2 and N3a,but the cumulative survival curves for N2 and N3a did not intersect.(4)Based on a Cox multivariate analysis,various independent risk factors for recurrence were identified(P<0.05).Conclusion Lymph node micrometastasis is an important risk factor for gastric cancer recurrence.Lymph node micrometastasis should be considered in TNM staging to determine prognosis and optimal treatment strategies.

Occurrence of No.12 lymph node micrometastasis in gastric cancer and its effect on clinicopathological parameters and prognosis

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.

Molecular Diagnosis of Micrometastasis in Lymph Nodes,Peripheral Blood and Bone Marrow in patients

Background and Objective Lymph node, peripheral blood and bone marrow from NSCLC patients have undetectable micro-metastasis by general method, and the tumor micrometastasis

单孔胸腔镜手术与三孔胸腔镜手术对老年非小细胞肺癌患者术后肿瘤微转移及应激反应影响的对比观察

目的对比单孔、三孔胸腔镜手术对老年非小细胞肺癌(NSCLC)患者术后肿瘤微转移、应激反应的影响。方法回顾性选取2020年1月至2023年1月江苏省肿瘤医院收治的老年NSCLC患者90例,参考手术方式不同分为单孔组(n=45)与多孔组(n=45),单孔组予以单孔胸腔镜手术,多孔组予以三孔胸腔镜手术。比较两组患者的围手术期指标(术中出血量、手术时间、术后引流量、术后住院时间、胸管留置时间、淋巴结清扫数目)、肿瘤微转移[基质金属蛋白酶9(MMP-9)、肿瘤坏死因子受体相关蛋白(TRAP)1、钙黏附蛋白E(E-cadherin)、Krüppel样因子(KLF)4]、应激反应[前列素E2(PGE2)、5-羟色胺(5-HT)、去甲肾上腺素(NE)、皮质醇]以及术后并发症发生率。结果单孔组的术中出血量、术后引流量、住院时间及胸管留置时间分别为(36.61±22.31)mL、(971.82±301.52)mL、(6.49±2.50)d、(4.13±1.56)d,均低于多孔组[(68.18±12.18)mL、(1289.39±604.57)mL、(8.32±3.71)d、(6.42±3.17)d],差异均有统计学意义(P<0.05);两组手术时间、淋巴结清扫总数目比较,差异均无统计学意义(P>0.05)。单孔组患者术后1周的MMP-9、TRAP1、E-cadherin、KLF4水平分别为0.35±0.03、0.40±0.05、2.89±0.29、2.87±0.29,均明显低于多孔组(0.46±0.09、0.52±0.22、3.16±0.53、3.13±0.34),差异均有统计学意义(P<0.05)。单孔组患者手术次日的PGE2、5-HT、NE、皮质醇水平分别为(182.87±10.29)pg/mL、(0.68±0.05)μmol/mL、(2.85±0.28)pg/mL、(95.69±10.05)ng/mL,均明显低于多孔组[(198.98±11.79)pg/mL、(0.91±0.14)μmol/mL、(4.71±0.57)pg/mL、(116.88±18.81)ng/mL],差异均有统计学意义(P<0.05)。术后两组患者的微小并发症、重大并发症以及总并发症发生率比较,差异均无统计学意义(P>0.05)。结论对于老年NSCLC患者,与三孔胸腔镜手术相比,采用单孔胸腔镜术围手术期恢复更快,应激反应更小,肿瘤细胞微转移活跃度更加稳定,具有良好的预后效果。

模式化单孔胸腔镜肺癌根治术对患者肺功能丢失及肿瘤微转移的影响

目的:探究模式化单孔胸腔镜肺癌根治术(VATS)对患者肺功能丢失及肿瘤微转移的影响。方法:选取2021年1月—2022年5月样本医院收治的68例行VATS患者作为研究对象,按照治疗方法不同将其分为研究组(n=34,采用模式化单孔VATS)和对照组(n=34,采用常规三孔VATS),比较两组患者手术相关指标、肺功能指标[第1秒呼吸容积(FEV1)、一氧化碳弥散量(DLCO)、用力肺活量(FVC)]、外周血肿瘤微转移指标[金属基质蛋白酶9(MMP-9)、肺特异性X蛋白(LUNX)、KLF4基因m RNA的相对表达量]、氧化应激指标[血清活性氧(ROS)、缺血修饰白蛋白(IMA)、晚期氧化蛋白产物(AOPP)]、并发症及复发情况。结果:研究组手术用时、术后引流量、术中出血量、住院时间均低于对照组,差异有统计学意义(χ^(2)=4.621、2.314、3.043、5.057,P<0.05);术后,两组患者FEV1、FVC、DLCO均降低,且研究组高于对照组,差异有统计学意义(P<0.05);术后,两组患者外周血MMP-9、LUNX m RNA表达均下降,KLF4 m RNA表达升高,且研究组MMP-9、LUNX m RNA表达低于对照组,KLF4 m RNA表达高于对照组,差异有统计学意义(P<0.05);术后,两组患者血清ROS、IMA、AOPP均升高,且研究组低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率均低于对照组,差异均有统计学意义(χ^(2)=4.660,P<0.05)。结论:模式化单孔VATS能明显改善患者肺功能丢失,降低转移肿瘤细胞活跃度和复发率,促进患者康复和改善预后。

pN0期非小细胞肺癌VEGF、Ki-67、p53表达与淋巴结微转移的相关性

目的:探讨pN0期非小细胞肺癌血管内皮生长因子(VEGF)、Ki-67、p53表达与淋巴结微转移相关性。方法:选择术后经常规病理检查证实为pN0期的非小细胞肺癌病人93例及手术治疗的非肺癌病人45例,采用免疫组织化学法检测肺癌组织及正常肺组织中VEGF、Ki-67和p53表达情况,分析肺癌组织中VEGF、Ki-67、p53表达与病人临床病理学特征的关系,并采用ROC曲线分析其对淋巴结微转移的诊断价值。结果:肺癌组织中VEGF、Ki-67和p53表达阳性率均明显高于正常肺组织(P<0.01)。不同TNM分期的非小细胞肺癌病人肺组织VEGF、Ki-67、p53表达阳性率差异均有统计学意义(P<0.05),而不同性别、年龄、病理类型、肿瘤最大径及吸烟史病人的VEGF、Ki-67、p53表达阳性率差异均无统计学意义(P>0.05)。淋巴结微转移的非小细胞肺癌病人VEGF、Ki-67、p53表达评分均明显高于无淋巴微转移病人(P<0.01)。VEGF、Ki-67、p53评分对非小细胞肺癌病人淋巴结微转移诊断AUC分别为0.816、0.877、0.821。结论:pN0期非小细胞肺癌病人肺组织VEGF、Ki-67及p53表达与肺癌的发生发展有关,且与病人淋巴结微转移有关,可作为病人淋巴结微转移的潜在检测指标。

胃癌胃周软组织微转移临床研究现状

微转移是胃癌患者复发和预后的潜在影响因素,当前关于胃癌微转移的研究大多集中于淋巴结、外周血和骨髓,鲜见研究关注胃周软组织。胃周软组织直接延伸于胃浆膜,由胃周系膜、韧带、网膜等组织构成,内含脉管、淋巴管、神经等重要结构,作为胃周淋巴结载体,是胃癌淋巴结转移的必经途径。分析胃癌胃周软组织不同成分的微转移情况,有望为淋巴结转移机制提供线索,完善现有胃癌TNM分期以及丰富预后影响因素。本文就胃周软组织微转移的定义、检测技术、影响因素和临床意义进行探讨。

一步核酸扩增法检测早期宫颈癌前哨淋巴结转移的效果

目的评价一步核酸扩增法(one-step nucleic acid amplification,OSNA)检测早期宫颈癌前哨淋巴结(sentinel lymph node,SLN)转移的效能及对非前哨淋巴结(nSLN)转移的预测价值。方法前瞻性纳入68例早期宫颈癌患者,收集术中SLN组织标本。所有患者均行系统盆腔淋巴结清扫。术中将每枚SLN分为2份,一份行OSNA检测,一份行快速冰冻切片(frozen section,FS)检测;术后病理检测结果作为诊断金标准。分析OSNA、FS与术后病理结果评估微转移(micrometastasis,MM)及宏转移(macrometastases,MC)的一致性,并比较评估特异度、灵敏度;比较OSNA与FS评估MC及MM的灵敏度。比较OSNA检出不同SLN阳性数患者盆腔nSLN阳性比例。结果68例患者中,共收集SLN130枚,43例检出1枚SLN、22例检出2枚SLN、3例检出2枚以上SLN,平均每例患者1.9枚SLN。术后病理检出阳性SLN 26枚(20.0%),其中13枚为MC、13枚为MM。OSNA检出阳性SLN 29枚(22.3%),其中13枚为MC、16枚为MM,4枚为假阳性;101枚OSNA阴性的SLN中,1枚术后病理检测为阳性。OSNA检测SLN转移的特异度、灵敏度、阴性预测值、阳性预测值分别为96.2%、96.2%、99.0%、86.2%(P=0.375),与术后病理一致性较好(Kappa值=0.885);FS检测SLN转移的特异度、灵敏度、阴性预测值、阳性预测值分别为100%、61.5%、91.2%、100%(P=0.002),与术后病理一致性一般(Kappa值=0.719)。对于MC SLN,OSNA与FS检出的灵敏度均为100%;对于MM SLN,OSNA检出灵敏度为92.3%、FS检出灵敏度为23.1%(P=0.030)。盆腔nSLN阳性患者中,OSNA检出阳性SLN>1枚患者比例高于检出1枚SLN阳性患者(77.8%vs 22.2%,P=0.041)。OSNA检出SLN阳性患者术后病理显示肿瘤细胞分化更差、增殖指数更高,且存在淋巴脉管侵犯。结论OSNA操作简便、快速,检测SLN转移的灵敏度与术后病理相近,高于FS,可用于术中判断早期宫颈癌SLN转移。

全腹腔镜下远端胃癌根治术对早中期胃癌患者胃肠道屏障功能及肿瘤微转移指标的影响

目的 探讨全腹腔镜下远端胃癌根治术对早中期胃癌患者胃肠道屏障功能及肿瘤微转移指标的影响。方法 选取2017年2月至2021年3月收治的120例早中期胃癌患者为研究对象,按照随机数字表法将其分为对照组与观察组,各60例。对照组行传统开腹术治疗,观察组行全腹腔镜下远端胃癌根治术治疗。比较两组的治疗效果。结果 观察组的术中出血量少于对照组,排气时间及住院时间短于对照组(P<0.05)。术后1 d,观察组的二胺氧化酶(DAO)、D-乳酸水平低于对照组(P<0.05)。术后1 d,观察组的核因子κB(NF-κB)、白细胞介素-6(IL-6)、白细胞介素-17(IL-17)水平低于对照组(P<0.05)。手术结束时,观察组的多巴脱羧酶(DDC)、癌胚抗原(CEA)水平低于对照组(P<0.05)。结论 全腹腔镜下远端胃癌根治术治疗早中期胃癌的效果较好,可有效保护胃肠道屏障功能,降低炎症反应程度,减少肿瘤微转移,值得推广。