Effect of the number of positive lymph nodes and lymph node ratio on prognosis of patients after resection of pancreatic adenocarcinoma

BACKGROUND： The prognostic factors related to lymph node involvement [lymph node status, the number of positive lymph nodes, lymph node ratio （LNR）] and the number of nodes evaluated in patients with pancreatic adenocarcinoma after pancreatectomy are poorly defined. METHODS： A total of 167 patients who had undergone resection of pancreatic adenocarcinoma from February 2010 to August 2011 were included in this study. Histological examination was performed to evaluate the tumor differentiation and lymph node involvement. Univariate and multivariate analyses were made to determine the relationship between the variables related to nodal involvement and the number of nodes and survival. RESULTS： The median number of total nodes examined was 10 （range 0-44） for the entire cohort. The median number of total nodes examined in node-negative （pN0） patients was similar to that in node-positive （pN1） patients. Patients with pN1 diseases had significantly worse survival than those with pN0 ones （P=0.000）. Patients with three or more positive nodes had a poorer prognosis compared with those with the negative nodes （P=0.000）. The prognosis of the patients with negative nodes was similar to that of those with one to two positive nodes （P=0.114）. The median survival of patients with an LNR ≥0.4 was shorter than that of patients with an LNR 〈0.4 in the pN1 cohort （P=0.014）. No significance was found between the number of total nodes examined and the prognosis, regardless of the cutoff of 10 or 12 and in the entire cohort or the pN0 and pN1 groups. Based on the multivariate analysis of the entire cohort and the pN1 group, the nodal status, the number of positive nodes and the LNR were all associated with survival. CONCLUSIONS： In addition to the nodal status, the number of positive nodes and the LNR can serve as comprehensive factors for the evaluation of nodal involvement. This approach may be more effective for predicting the survival of patients with pancreatic adenocarcinoma after pancreatectomy.

The number of tumor-free axillary lymph nodes removed as a prognostic parameter for node-negative breast cancer

Recently, there has been controversy about the relationship between the number of lymph nodes removed and survival of patients diagnosed with lymph node-negative breast cancer. To assess this relationship, 603 cases of lymph node-negative breast cancer with a median of 126 months of follow-up data were studied. Patients were stratified into two groups(Group A, 10 or fewer tumor-free lymph nodes removed; Group B, more than 10 tumor-free lymph nodes removed). The number of tumor-free lymph nodes in ipsilateral axillary resections as well as 5 other disease parameters were analyzed for prognostic value. Our results revealed that the risk of death from breast cancer was significantly associated with patient age, marital status, histologic grade, tumor size, and adjuvant therapy. The 5- and 10-year survival rates for patients with 10 or fewer tumor-free lymph nodes removed was 88.0% and 66.4%, respectively, compared with 69.2% and 51.1%, respectively, for patients with more than 10 tumor-free lymph nodes removed. For patients with 10 or fewer tumor-free lymph nodes removed, the adjusted hazard ratio(HR) for risk of death from breast cancer was 0.579(95% confidence interval, 0.492-0.687, P < 0.001), independent of patient age, marital status, histologic grade, tumor size, and adjuvant therapy. Our study suggests that the number of tumor-free lymph nodes removed is an independent predictor in cases of lymph node-negative breast cancer.

Metastatic lymph nodes and prognosis assessed by the number of retrieved lymph nodes in gastric cancer

BACKGROUND The prognostic value of quantitative assessments of the number of retrieved lymph nodes(RLNs)in gastric cancer(GC)patients needs further study.AIM To discuss how to obtain a more accurate count of metastatic lymph nodes(MLNs)based on RLNs in different pT stages and then to evaluate patient prognosis.METHODS This study retrospectively analyzed patients who underwent GC radical surgery and D2/D2+LN dissection at the Cancer Hospital of Harbin Medical University from January 2011 to May 2017.Locally weighted smoothing was used to analyze the relationship between RLNs and the number of MLNs.Restricted cubic splines were used to analyze the relationship between RLNs and hazard ratios(HRs),and X-tile was used to determine the optimal cutoff value for RLNs.Patient survival was analyzed with the Kaplan-Meier method and log-rank test.Finally,HRs and 95%confidence intervals were calculated using Cox proportional hazards models to analyze independent risk factors associated with patient outcomes.RESULTS A total of 4968 patients were included in the training cohort,and 11154 patients were included in the validation cohort.The smooth curve showed that the number of MLNs increased with an increasing number of RLNs,and a nonlinear relationship between RLNs and HRs was observed.X-tile analysis showed that the optimal number of RLNs for pT1-pT4 stage GC patients was 26,31,39,and 45,respectively.A greater number of RLNs can reduce the risk of death in patients with pT1,pT2,and pT4 stage cancers but may not reduce the risk of death in patients with pT3 stage cancer.Multivariate analysis showed that RLNs were an independent risk factor associated with the prognosis of patients with pT1-pT4 stage cancer(P=0.044,P=0.037,P=0.003,P<0.001).CONCLUSION A greater number of RLNs may not benefit the survival of patients with pT3 stage disease but can benefit the survival of patients with pT1,pT2,and pT4 stage disease.For the pT1,pT2,and pT4 stages,it is recommended to retrieve 26,31 and 45 LNs,respectively.

Prognostic significance of the number of pelvic lymph nodes removed in patients with early cervical cancer

Objective The aim of this research was to study the prognostic significance of the number of pelvic lymph nodes removed in patients with early cervical cancer.Methods We searched the Pub Med database using the terms "cervical cancer" and "lymph nodes" or "lymphadenectomy". Studies on the association between number of lymph nodes removed and prognosis or survival were identified. We retrospectively studied the relevant research.Results Ten retrospective studies were included. Two studies indicated that the number of lymph nodes had no association with prognosis whereas three studies found a positive relationship. Five studies indicated some factors that could influence the relationship between number of lymph nodes and prognosis.Conclusion The number of lymph nodes removed may positively influence the prognosis of patients with cervical cancer. Some factors may influence the relationship between the extent of lymph nodes removed and patient prognosis. Additional multicenter, prospective studies with large samples are required to confirm the study findings.

Relationship between celiac artery variation and number of lymph nodes dissection in gastric cancer surgery

BACKGROUND Radical D2 lymphadenectomy for advanced gastric cancer as a standard procedure has gained global consensus. Mounting studies have shown that the number of lymph nodes dissection directly affects the prognosis and recurrence of gastric cancer. Our previous study showed that there was no obvious lymph node around the abnormal hepatic artery derived from the superior mesenteric artery. AIM To investigate the relationship between celiac artery variation and the number of lymph nodes dissection in gastric cancer surgery. METHODS The clinicopathological data of 421 patients treated with radical D2 lymphadenectomy were analyzed retrospectively. The difference of the number of lymph nodes dissection between the celiac artery variation group and the normal vessels group and the relationship with prognosis were analyzed. RESULTS Celiac artery variation was found in 110 patients, with a variation rate of 26.13%. Celiac artery variation, tumor staging, and Borrmann typing were factors that affected lymph node clearance in gastric cancer, and the number of lymph nodes dissection in patients with celiac artery variation was significantly less than that of non-variant groups (P < 0.05). Univariate analysis showed that there was no significant difference in survival time between the two groups (P > 0.05). Univariate and multiple Cox regression analysis showed that celiac artery variation was not a prognostic factor for gastric cancer (P > 0.05). Tumor staging, intraoperative bleeding, and positive lymph node ratio were prognostic factors for gastric cancer patients (all P < 0.05). CONCLUSION The number of lymph nodes dissection in patients with celiac artery variation was reduced, but there was no obvious effect on prognosis. Therefore, lymph nodes around the abnormal hepatic artery may not need to be dissected in radical D2 lymphadenectomy.

Neoadjuvant chemoradiotherapy for esophageal cancer:Impact on extracapsular lymph node involvement

AIM:To assess the effects of neoadjuvant chemoradiotherapy(CRT) on the presence of extracapsular lymph node involvement(LNI) and its prognostic value in patients with resected esophageal cancer.METHODS:Two hundred and ninety-eight patients with advanced esophageal cancer underwent esophagectomy between 1997 and 2006.One hundred and ninety patients(63.8%) were treated with neoadjuvant CRT prior to resection.A total of 986 metastatic LNs were examined.Survival of the patients was analyzed according to intra-and extra-capsular LNI.RESULTS:Five-year survival rate was 22.5% for the entire patient population.Patients with extracapsular LNI had a 5-year survival rate of 16.7%,which was comparable to the 15.8% in patients with infiltrated nodes of the celiac trunk(pM1lymph).In contrast to patients treated with surgery alone,neoadjuvant therapy resulted in signif icantly(P = 0.001) more patients with pN0/M0(51.6% vs 25.0%).In 17.6% of the patients with surgery alone vs 16.8% with neoadjuvant CRT,extracapsular LNI was detected.Neoadjuvant therapy does not reduce the occurrence of extracapsular LNI.CONCLUSION:Extracapsular LNI is an independent negative prognostic factor not influenced by neoadjuvant CRT.In a revised staging system for esophageal cancer,extracapsular LNI should be considered.

Does lymph node dissection improve the prognosis of patients with colorectal cancer?

The number of lymph nodes(LNs)dissected during surgery has become an interesting topic.Simple intuition always leads us to believe that dissecting more LNs will result in more accurate pathological staging and assurance of surgical quality.However,when the number of LNs dissected reaches a certain threshold,the patient’s prognosis does not continue to improve as the number of dissected nodes increases.Instead,an increase in the number of dissected LNs may be accompanied by a higher incidence of complications.Currently,there are only less than 40%of colorectal cancer patients undergoing adequate LN evaluation.Therefore,obtaining a sufficient number of LNs in clinical practice is extremely challenging.How to further address the insufficiency of LN dissection due to various reasons,which results in concerns of surgeons about patient prognosis,is currently a critical focus.

The value of the lymph node ratio and total number of lymph nodes examined for resected pancreatic signet ring cell carcinoma:a retrospective cohort study

Background:Pancreatic signet ring cell carcinoma(SRCC)is an exceedingly rare histological subtype of pancreatic cancer.Previous studies have focused on the trends of incidence and independent predictors of pancreatic SRCC.Our objectives of the study were to analyze the prognostic value of the lymph node ratio(LNR)and to explore the minimal number of lymph nodes examined to accurately evaluate the N stage in resected pancreatic SRCC.Method:We analyzed 120 patients diagnosed from January 1,1990,to December 31,2016,constituted the study cohort from the Surveillance,Epidemiology,and End Results(SEER)registry.We calculated the overall survival(OS)of these patients by using a Kaplan–Meier analysis.The Kaplan–Meier analysis was used to analyze the influence of various factors on the prognosis of patients in the univariate analysis.The multivariate Cox analysis were applied to find independent prognostic factors of patients with pancreatic SRCC.Receiver-operating characteristic curve(ROC)analysis to investigate the discriminatory ability of the total number of lymph nodes examined(TNLE)relative to whether lymph node metastasis was present.Results:The median number of lymph nodes examined among 120 patients with resected pancreatic SRCC was 14(interquartile range:6.25–20.0).According to the univariate analysis of OS,age,grade,chemotherapy,LNR,and TNLE were significantly different(P<.05).We demonstrated the prognostic benefit of chemotherapy in resected pancreatic SRCC,whereas radiotherapy was not associated with improved survival.The multivariate survival analysis showed that LNR and grade were independent prognostic indicators after pancreatic SRCC resection for OS.TNLE≥8 showed the highest discriminatory power for evaluating lymph node metastasis(Area under curve(AUC):0.656,95%confidence interval:0.564–0.741,Youden index:0.2533,sensitivity:78.67%,specificity:46.67%,P=.003).Conclusion:Our study indicated that the LNR was a valuable independent prognostic factor for resected pancreatic SRCC.Regional lymphadenectomy of at least 8 lymph nodes was necessary to accurately stage patients.An adequate number of lymph nodes examined are necessary for clinicians to accurately predict the significance of the LNR in resected pancreatic SRCC.

Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: A systematic review

AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P<0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma insitu component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.

Diagnostic Accuracy of MRI in Primary Cervical Cancer

Introduction: Magnetic resonance imaging (MRI) studies obtained during the initial staging of patients affected by uterine cervical cancer were compared to the final histological report after surgery. Methods: Data were retrieved from published papers. Results: MRI detection of lymph node metastases shows a sensitivity of 49.3% (1209 patients) and a specificity of 87.7% (1182 patients). Parametrial involvement detection has 66.2% sensitivity (1288 patients) and 83.6% specificity (1282 patients). MRI tumor size evaluation shows significant error. Even detection of over 1 cm diameter primary tumor can fail. MRI appears promising in the detection of myometrial and endometrial involvement. Conclusions: Primary uterine cervical cancer evaluation with routine MRI has a limited accuracy especially in the detection of lymph node involvement and parametrial invasion. It is not sensitive enough to replace histology of dissected nodes and parametria. Tumor size estimation is imprecise. Detection of myometrial and endometrial invasion using MRI might be possible. Awareness of MRI limitations is crucial in primary cervical cancer staging.

Non-surgical factors influencing lymph node yield in colon cancer

There are numerous factors which can affect the lymph node(LN) yield in colon cancer specimens.The aim of this paper was to identify both modifiable and nonmodifiable factors that have been demonstrated toaffect colonic resection specimen LN yield and to summarise the pertinent literature on these topics.A literature review of Pub Med was performed to identify the potential factors which may influence the LN yield in colon cancer resection specimens.The terms used for the search were:LN,lymphadenectomy,LN yield,LN harvest,LN number,colon cancer and colorectal cancer.Both nonmodifiable and modifiable factors were identified.The review identified fifteen non-surgical factors:(13 nonmodifiable,2 modifiable) which may influence LN yield.LN yield is frequently reduced in older,obese patients and those with male sex and increased in patients with right sided,large,and poorly differentiated tumours.Patient ethnicity and lower socioeconomic class may negatively influence LN yield.Pre-operative tumour tattooing appears to increase LN yield.There are many factors that potentially influence the LN yield,although the strength of the association between the two varies greatly.Perfecting oncological resection and pathological analysis remain the cornerstones to achieving good quality and quantity LN yields in patients with colon cancer.

腹腔镜辅助全胃切除手术在不同年龄段局部进展期胃癌患者中的应用效果

目的分析腹腔镜辅助全胃切除手术在不同年龄段局部进展期胃癌(LAGC)患者中的应用效果。方法选择2017年4月至2023年4月收治的80例LAGC患者纳入本次研究,以年龄段将其分为A组(≤55岁,n=11)、B组(56~70岁,n=28)、C组(>70岁,n=41)。三组均给予腹腔镜辅助全胃切除手术治疗。比较三组的手术效果。结果三组的手术时长、术中失血量、淋巴结清扫数量、术后排气时间、恢复正常饮食时间、总住院时长比较,差异无统计学意义(P>0.05)。三组的术后并发症总发生率比较,差异无统计学意义(P>0.05)。术前、术后,三组的C反应蛋白(CRP)、去甲肾上腺素(NE)、前列腺素E_(2)(PGE_(2))、髓过氧化物酶(MPO)、癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原724(CA724)水平比较,差异无统计学意义(P>0.05);术后,三组的CRP、NE、PGE_(2)、MPO水平均高于术前,CEA、CA199、CA724水平低于术前,差异具有统计学意义(P<0.05)。结论腹腔镜辅助全胃切除手术应用于不同年龄段LAGC患者中均可取得较佳手术效果,且未增加应激反应及严重并发症,值得临床应用与推广。

Tis~T1期非小细胞肺癌脏层胸膜受累与淋巴结转移的相关性

目的探讨Tis~T1期非小细胞肺癌(NSCLC)脏层胸膜受累情况与淋巴结转移的相关性。方法回顾性分析84例Tis~T1期NSCLC患者的临床资料。所有患者均行肺叶切除术+系统性淋巴结清扫术治疗,术后将病理标本送检,明确患者胸膜脏层浸润(VPI)状态,依据VPI分为分为PL0组与PL1/PL2组。收集两组患者年龄、性别、体质量指数、基础疾病、肿瘤大小、病理类型、肿瘤位置、脉管瘤栓、术前癌胚抗原(CEA)水平、基础疾病及淋巴结转移情况等资料。分析VPI与临床病理特征及淋巴结转移的关系。结果84例患者中18例合并VPI,脏层胸膜受累率为21.43%(18/84);PL1/PL2组肿瘤大小2~3 cm、术前CEA水平≥3.5 ng/L占比高于PL0组,差异有统计学意义(P<0.05);PL1/PL2组淋巴结转移率、N2比率高于PL0组,差异有统计学意义(P<0.05)。结论Tis~T1期NSCLC患者VPI与淋巴结转移存在密切关系,当合并VPI时则需考虑存在淋巴结转移,术中应予以广泛淋巴结清扫,避免术后复发转移。

腹腔镜结肠癌根治术治疗结肠癌的疗效及对胃肠道功能的影响分析

目的探讨在结肠癌的治疗中采用腹腔镜手术的临床效果及对患者胃肠道功能的影响。方法选取58例结肠癌患者,采用随机数字表法分成对照组和研究组,每组29例。对照组采用传统开放手术治疗,研究组采用腹腔镜结肠癌根治术治疗。对比两组围手术期相关指标、淋巴结清扫数量、血清炎性指标、血清应激指标及并发症发生率。结果研究组术中出血量(87.63±6.24)ml、术后引流量(24.32±2.05)ml较对照组的(122.25±9.52)、(30.23±2.63)ml少,手术时间(136.15±7.16)min、术后排气时间(3.14±0.26)d、肠鸣音恢复时间(2.34±0.43)d、恢复饮食时间(68.74±4.23)h、住院时间(10.42±1.16)d均较对照组的(141.05±8.75)min、(4.25±0.55)d、(3.58±0.75)d、(87.36±5.52)h、(15.27±1.44)d短(P<0.05)。两组肿瘤分期Ⅰ、Ⅱ期淋巴结清扫数量无显著差异(P>0.05);研究组肿瘤分期Ⅲ期淋巴结清扫数量、阳性淋巴结清扫数量、左半结肠淋巴结清扫数量、右半结肠淋巴结清扫数量分别为(25.11±2.02)、(21.06±2.14)、(18.87±1.42)、(24.23±2.14)个,均多于对照组的(17.58±1.36)、(12.25±1.23)、(16.25±1.26)、(18.54±1.52)个(P<0.05)。术后,对照组白细胞介素-6(IL-6)为(28.85±2.12)pg/ml,C反应蛋白(CRP)为(12.36±1.42)mg/L;研究组IL-6为(17.96±1.63)pg/ml,CRP为(8.64±1.15)mg/L,研究组IL-6、CRP较对照组低(P<0.05)。术后,对照组肾上腺素为(99.87±7.58)pg/ml,去甲肾上腺素为(176.52±9.36)pg/ml,皮质醇为(24.63±2.14)pg/ml;研究组肾上腺素为(64.25±4.31)pg/ml,去甲肾上腺素为(87.56±5.15)pg/ml,皮质醇为(13.54±1.63)pg/ml,两组较术前均有所升高,而研究组肾上腺素、去甲肾上腺素、皮质醇均较对照组低(P<0.05)。研究组并发症发生率(6.90%)较对照组(31.03%)低(P<0.05)。结论在结肠癌治疗中采用腹腔镜结肠癌根治术治疗可提高淋巴结清扫数量,缩短术后胃肠功能的恢复时间,改善血清炎性指标水平,减少应激反应,术后并发症发生率较低,有利于术后机体的康复,建议临床广泛应用。

阴性淋巴结数对浸润性乳腺癌预后的评估价值

目的分析阴性淋巴结数对浸润性乳腺癌(IBC)患者预后的评估价值。方法回顾性分析84例IBC患者的病历有关资料,统计其阴性淋巴结检出数目,分析淋巴结数目与IBC患者临床病理特征以及预后的关系。结果84例IBC患者,共检出648枚阴性淋巴结,人均检出7.7枚;将人均检出的7.7枚阴性淋巴结取整数后,以阴性淋巴结检出数目8枚作为界值,把所有患者划分为2组,其中阴性淋巴结≥8枚组共38例,阴性淋巴结<8枚组共46例。2组的年龄、BMI、疾病类型相比,差异无统计学意义(P>0.05);而阴性淋巴结≥8枚组中TNM为Ⅰ~Ⅱ期、辅助化疗患者占比分别为78.95%(30/38)、68.42%(26/38),高于阴性淋巴结<8枚组的34.78%(16/46)、28.26%(13/46),差异有统计学意义(P<0.05)。阴性淋巴结≥8枚组的1年生存率为92.11%(35/38),高于阴性淋巴结<8枚组的73.91%(34/46),差异有统计学意义(P<0.05)。结论阴性淋巴结检出数与IBC患者的预后密切相关,阴性淋巴结检出数少,则患者预后差,临床需予以高度关注。

分化型甲状腺癌手术中应用纳米碳混悬注射液的效果分析

目的分析分化型甲状腺癌患者手术中应用纳米碳混悬注射液的治疗效果。方法回顾性收集2021年1月至2023年12月河北省承德市中心医院收治的92例行甲状腺全切+单侧中央区淋巴清扫术患者的临床资料,根据治疗方法不同分为纳米碳组(纳米碳混悬注射液治疗,n=46)和对照组(常规手术治疗,n=46),比较两组治疗效果。结果纳米碳组的颈部淋巴结清扫个数(6.37±4.44)多于对照组(t=3.919,P<0.001),颈部淋巴结转移的检出率(56.5%)高于对照组(χ^(2)=10.172,P=0.001),甲状旁腺误切率(6.5%)低于对照组(χ^(2)=4.389,P=0.036)。纳米碳组术后7 d内低钙症状发生率(8.7%)低于对照组(χ^(2)=4.842,P=0.028),且术后7 d内总的相关并发症发生率(13.0%)低于对照组(χ^(2)=5.974,P=0.015)。结论分化型甲状腺癌患者手术中应用纳米碳混悬注射液,能够提高颈部淋巴结转移的检出率,增加颈部淋巴结清扫个数以及降低甲状旁腺的误切率,还可以降低患者术后7 d内相关并发症的发生率,并对降低患者术后7 d内低钙症状的发生率有显著影响。

甲状腺乳头状癌预防性中央区淋巴结清扫获得淋巴结数目的影响因素

目的探讨影响甲状腺乳头状癌行单侧腺叶及峡部切除联合预防性同侧中央区淋巴结清扫术获得淋巴结数目的因素,分析变化规律,以期为临床治疗甲状腺乳头状癌提供重要依据。方法回顾性分析锦州医科大学附属第一医院甲状腺外科于2019年1月至2022年1月因甲状腺乳头状癌收治入院并行单侧腺叶及峡部切除联合预防性同侧中央区淋巴结清扫术的患者193例的临床和病理资料,将病理所获得淋巴结数目分为高获得淋巴结数目组(n>6枚)和低获得淋巴结数目组(n≤6枚),采用单因素分析和多因素分析的方法找出影响高获得淋巴结数目的影响因素,通过相关分析判断获得淋巴结数目对中央区淋巴结转移的影响,此外,通过术后并发症分析获得淋巴结数目对患者生存质量的影响。结果获得淋巴结数目与中央区淋巴结转移数目(r=0.240,P<0.05)和淋巴结转移率(r=0.161,P<0.05)分别呈线性正相关,控制转移淋巴结数目不变,淋巴结转移率随获得淋巴结数的上升而降低(r=-0.444,P<0.05)。两组获得淋巴结数目单因素分析比较,性别、年龄、手术时长、BMI、肿瘤最大直径、多灶性、桥本甲状腺炎、病灶位置、被膜侵犯、对侧甲状腺结节、甲状旁腺移植、BRAF基因V600E突变差异无统计学意义(P>0.05),应用纳米碳在两组比较中差异有统计学意义(P<0.05),logistic二元回归分析结果显示合并桥本氏甲状腺炎和应用纳米碳是高获得淋巴结数目的独立影响因素(P<0.05)。ROC曲线分析提示应用纳米碳所占曲线下面积为0.658(95%CI:0.580~0.735,P<0.05),桥本甲状腺炎所占曲线下面积为0.584(95%CI:0.504~0.665,P<0.05)。此外,术后患者声带麻痹和淋巴漏的发生在高、低获得淋巴结数目组之间差异无统计学意义(P>0.05)。结论控制中央区淋巴结转移数目不变,获得淋巴结数目越多,淋巴结转移率越低,应用纳米碳及患者合并桥本甲状腺炎可提高获得淋巴结数目,高、低获得淋巴结数目在术后并发症的发生率方面无明显差别。

小儿肾母细胞瘤患者淋巴结受累情况及取样数量与其预后的关系

目的分析小儿肾母细胞瘤(WT)患者淋巴结受累情况及取样数量与其预后的关系。方法收集2010年9月至2018年5月我院收治的WT患儿157例,分析患儿淋巴结受累情况及取样数量对5年无事件生存率(EFS)的影响。结果淋巴结受累患儿5年EFS为50.00%(10/20),淋巴结未受累患儿5年EFS为87.59%(120/137),淋巴结未受累患儿5年EFS明显高于淋巴结受累患儿(P<0.05);在不同病理类型亚组中,淋巴结受累的预后不良型(uFH)患儿生存情况明显低于预后良好型(FH)患儿(P<0.05);未受累患儿的淋巴结取样数量中位数为3个(0~18个),淋巴结受累患儿取样数量的中位数为9个(2~23个)。当术中取样超过7个时检出阳性淋巴结的概率越高,当术中取样数量在10个及以上时,淋巴结阳性率无明显增加。不同病理类型、术前是否进行化疗的WT患儿术中淋巴结取样数量比较,差异无统计学意义(P>0.05),而不同临床分期的WT患儿术中取样数量比较,差异有统计学意义(P<0.05);存在13.46%的Ⅰ期患儿及27.14%的Ⅱ期患儿术中采集淋巴结数量达到7个及以上,而40.00%的Ⅲ期患儿术中采集至少7个淋巴结。不同取样数量的Ⅱ、Ⅲ期WT患儿5年EFS比较,差异无统计学意义(P>0.05)。结论淋巴结受累是导致WT患儿预后不良的重要因素,而淋巴结取样数量对患儿预后不具有独立预测价值,当取样超过7个时检出阳性淋巴结的概率大大提升。

COX-2、p53、PCNA和nm23异常表达与胃癌生物学行为的关系

背景及目的:分子生物学研究表明COX-2、p53、PCNA和nm23基因蛋白异常表达与胃癌发生发展密切相关,有关它们异常表达与胃癌生物学行为的关系尚不清楚。本文旨在了解它们与胃癌临床病理生物学行为的关系。方法:用免疫组化(SP)方法检测胃癌手术切除71例标本中上述基因表达。结果:(1)胃癌COX-2过表达率为70.4%(50/71例),且过表达与肿瘤大小、大体类型、组织学类型、淋巴结转移(LN)及临床病理分期密切相关(P<0.05或0.01)。(2)71例胃癌标本的p53和PCNA过表达率分别为74.6%和78.9%,其中LN(+)胃癌p53和PCNA过表达(86.7%和88.8%)分别高于LN(-)病例(53.8%和61.5%)(P<0.05),且Ⅰ+Ⅱ期胃癌的p53和PCNA过表达率分别(52.2%和60.9%)显著低于Ⅲ+Ⅳ期病例(85.4%和87.5%)(P<0.05)。(3)LN(-)病例的nm23低表达率(88.5%)显著低于LN(+)病例的62.2%(P<0.05);且Ⅰ+Ⅱ期病例的nm23低表达91.3%明显高于Ⅲ+Ⅳ期病例62.5%(P<0.05)。(4)COX-2与p53、PCNA和nm23基因2个以上表达病例与表达异常或单因素表达异常者相比,在组织学类型、癌浸润深度、淋巴结转移及临床分期差异显著(P<0.05或P<0.01)。结论:胃癌COX-2与p53、PCNA和nm23异常表达与胃癌淋巴结转移和疾病进展等生物学行为密切相关。

甲状腺乳头状癌淋巴结转移率和远处转移的关系

背景与目的:颈部淋巴结转移在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中多见。该研究旨在探讨PTC淋巴结转移率(the rate of involved lymph nodes,LR)与远处转移(distant metastasis,DM)的关系,及其对DM的预测价值。方法:随访162例PTC患者,将其分为DM组(M_1组)41例和非DM组(M_0组)121例,采用t检验、χ~2检验分别比较两组患者的基本病理特征。采用多因素分析评估LR在预测DM的意义。利用受试者工作特征(receiver operating characteristic curve,ROC)曲线及最佳诊断界值点评估LR及淋巴结转移数目(the number of involved lymph nodes,LNs)对DM的预测价值,进一步采用Kaplan-Meier曲线评估LR及LNs发生DM的累积风险,使用Log-rank法对差异进行统计学分析。结果:两组患者在年龄及多灶性方面差异无统计学意义(P>0.05),在男性(χ~2=13.039,P=0.000)、腺外侵犯(χ~2=2.941,P=0.000)、病灶大小(t=-4.485,P=0.000)方面存在显著差异。LR可以作为预测DM的独立因素(OR=1.133,P=0.000)。随着LR的增高,LNs大于等于15组患者的DM风险显著高于LNs小于15组(P=0.0002)。结论:LR可作为DM的独立预测指标,其与LNs结合可以更好地预测DM的发生风险。