Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the acc...Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the accuracy of sonography in the diagnosis of loco-regional lymphatic recurrences in comparison to the core needle biopsy results. Materials and Methods: Among 6455 patients who were followed up with clinical examination, mammography and ultrasound between January 2004 and November 2011, 125 (1.93%) patients had to be investigated with a core needle biopsy of a sonographically suspicious loco-regional lymph node. Results: Among the whole series, a total of 142 ultrasound-guided core needle biopsies were performed. Follow-up for the primary tumor lasted for a median time of 6.1 years (range 1 - 27 years). Ultrasound of suspicious loco-regional lymph nodes showed a sensitivity of 89.5%, a specificity of 87.1% and a positive predictive value of 89.5%. Conclusions: In our experience, ultrasound of suspicious loco-regional lymph nodes showed good accuracy and it should be a part of the standard examinations performed during follow-up for breast cancer.展开更多
Background:Despite numerous previous studies,the consideration of tumor location as a prognostic factor in resectable non-small cell lung cancer(NSCLC)remains controversial.The present study analyzed the association b...Background:Despite numerous previous studies,the consideration of tumor location as a prognostic factor in resectable non-small cell lung cancer(NSCLC)remains controversial.The present study analyzed the association between tumor location and clinical outcome in patients with resectable NSCLC who had undergone lobectomy with systematic lymphadenectomy and who had presented with varying nodal statuses.Methods:The data from a cohort of 627 eligible patients treated in Sun Yat-sen University Cancer Center between January 2000 and December 2008 were retrospectively collected,and the nodal statuses of patients with different tumor locations were compared.Cox proportional hazards regression model was used to determine the independent factors related to cancer-specific survival(CSS).Results:Multivariate analysis demonstrated that left lower lobe(LLL)tumors[hazard ratio(HR):1.465,95%confidence interval(CI)1.090-1.969,P=0.011],lymph node metastasis(HR:2.742,95%CI 2.145-3.507,P<0.001),and a tumor size of>4 cm(HR:1.474,95%CI 1.151-1.888,P=0.002)were three independent prognosticators in patients with resectable NSCLC.However,LLL tumors were associated only with CSS in node-positive patients(HR:1.528,95%CI 1.015-2.301,P=0.042),and a tumor size of>4 cm was the only independent risk predictor in the node-negative subgroup(HR:1.889,95%CI 1.324-2.696,P<0.001).Conclusions:Tumor location is related to the long-term CSS of NSCLC patients with lymph node metastasis.LLL tumors may be upstaged in node-positive patients to facilitate an optimal treatment strategy.展开更多
BACKGROUND Gallbladder cancer(GBC)is the most common biliary malignancy and has the worst prognosis,but aggressive surgeries[e.g.,resection of the extrahepatic bile duct(EHBD),major hepatectomy and lymph node(LN)disse...BACKGROUND Gallbladder cancer(GBC)is the most common biliary malignancy and has the worst prognosis,but aggressive surgeries[e.g.,resection of the extrahepatic bile duct(EHBD),major hepatectomy and lymph node(LN)dissection]may improve long-term survival.GBC may be suspected preoperatively,identified intraoperatively,or discovered incidentally on histopathology.AIM To present our data together with a discussion of the therapeutic strategies for GBC.METHODS We retrospectively investigated nineteen GBC patients who underwent surgical treatment.RESULTS Nearly all symptomatic patients had poor outcomes,while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery.Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs.Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus.All patients with positive surgical margins(e.g.,the biliary cut surface)showed poor outcomes.Hepatectomies were performed in sixteen patients,nearly all of which were minor hepatectomies.Metastases were observed in the left-sided liver but not in the caudate lobe.We may need to reconsider the indications for major hepatectomy,minimizing its use except when it is required to accomplish negative bile duct margins.Only a few patients received neoadjuvant or adjuvant chemoradiation.There were significant differences in overall and disease-free survival between patients with stages≤IIB and≥IIIA disease.The median overall survival and disease-free survival were 1.66 and 0.79 years,respectively.CONCLUSION Outcomes for GBC patients remain unacceptable,and improved therapeutic strategies,including neoadjuvant chemotherapy,optimal surgery and adjuvant chemotherapy,should be considered for patients with advanced GBCs.展开更多
文摘Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the accuracy of sonography in the diagnosis of loco-regional lymphatic recurrences in comparison to the core needle biopsy results. Materials and Methods: Among 6455 patients who were followed up with clinical examination, mammography and ultrasound between January 2004 and November 2011, 125 (1.93%) patients had to be investigated with a core needle biopsy of a sonographically suspicious loco-regional lymph node. Results: Among the whole series, a total of 142 ultrasound-guided core needle biopsies were performed. Follow-up for the primary tumor lasted for a median time of 6.1 years (range 1 - 27 years). Ultrasound of suspicious loco-regional lymph nodes showed a sensitivity of 89.5%, a specificity of 87.1% and a positive predictive value of 89.5%. Conclusions: In our experience, ultrasound of suspicious loco-regional lymph nodes showed good accuracy and it should be a part of the standard examinations performed during follow-up for breast cancer.
基金funded by the Guangdong Provincial Science and Technology Project(Grant No.2013B021800070)
文摘Background:Despite numerous previous studies,the consideration of tumor location as a prognostic factor in resectable non-small cell lung cancer(NSCLC)remains controversial.The present study analyzed the association between tumor location and clinical outcome in patients with resectable NSCLC who had undergone lobectomy with systematic lymphadenectomy and who had presented with varying nodal statuses.Methods:The data from a cohort of 627 eligible patients treated in Sun Yat-sen University Cancer Center between January 2000 and December 2008 were retrospectively collected,and the nodal statuses of patients with different tumor locations were compared.Cox proportional hazards regression model was used to determine the independent factors related to cancer-specific survival(CSS).Results:Multivariate analysis demonstrated that left lower lobe(LLL)tumors[hazard ratio(HR):1.465,95%confidence interval(CI)1.090-1.969,P=0.011],lymph node metastasis(HR:2.742,95%CI 2.145-3.507,P<0.001),and a tumor size of>4 cm(HR:1.474,95%CI 1.151-1.888,P=0.002)were three independent prognosticators in patients with resectable NSCLC.However,LLL tumors were associated only with CSS in node-positive patients(HR:1.528,95%CI 1.015-2.301,P=0.042),and a tumor size of>4 cm was the only independent risk predictor in the node-negative subgroup(HR:1.889,95%CI 1.324-2.696,P<0.001).Conclusions:Tumor location is related to the long-term CSS of NSCLC patients with lymph node metastasis.LLL tumors may be upstaged in node-positive patients to facilitate an optimal treatment strategy.
文摘BACKGROUND Gallbladder cancer(GBC)is the most common biliary malignancy and has the worst prognosis,but aggressive surgeries[e.g.,resection of the extrahepatic bile duct(EHBD),major hepatectomy and lymph node(LN)dissection]may improve long-term survival.GBC may be suspected preoperatively,identified intraoperatively,or discovered incidentally on histopathology.AIM To present our data together with a discussion of the therapeutic strategies for GBC.METHODS We retrospectively investigated nineteen GBC patients who underwent surgical treatment.RESULTS Nearly all symptomatic patients had poor outcomes,while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery.Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs.Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus.All patients with positive surgical margins(e.g.,the biliary cut surface)showed poor outcomes.Hepatectomies were performed in sixteen patients,nearly all of which were minor hepatectomies.Metastases were observed in the left-sided liver but not in the caudate lobe.We may need to reconsider the indications for major hepatectomy,minimizing its use except when it is required to accomplish negative bile duct margins.Only a few patients received neoadjuvant or adjuvant chemoradiation.There were significant differences in overall and disease-free survival between patients with stages≤IIB and≥IIIA disease.The median overall survival and disease-free survival were 1.66 and 0.79 years,respectively.CONCLUSION Outcomes for GBC patients remain unacceptable,and improved therapeutic strategies,including neoadjuvant chemotherapy,optimal surgery and adjuvant chemotherapy,should be considered for patients with advanced GBCs.
