PET/CT纵隔淋巴结SUVmax与N_0～N_1期非小细胞肺癌手术患者预后相关性的研究

目的:评价NSCLC患者行根治性切除术后,纵隔淋巴结组织学检查阴性(N0～N1期)的患者术前纵隔淋巴结FDG摄取水平对患者预后的意义。方法:回顾性总结了2005年4月至2009年5月在天津医科大学附属肿瘤医院行PET/CT检查后接受手术治疗的N0～N1期NSCLC患者的PET/CT数据、术后随访资料及临床资料。运用Kaplan-Meier法及Log-rank检验对纵隔淋巴结SUVmax以及性别、年龄、组织学类型、TNM分期、术后辅助治疗、原发病灶SUVmax等分别与患者生存时间进行单因素生存分析,采用Cox回归风险比例模型对影响预后的各因素进行多因素生存分析。结果:单因素分析表明,术前PET/CT纵隔淋巴结SUVma(xP=0.001)以及TNM分期(P<0.001)、原发病灶SUVma(xP=0.001)、是否有术后辅助治疗(P=0.012)对N0～N1期NSCLC患者术后预后存在预测作用;多因素分析表明,只有TNM分期(P=0.017)、原发病灶SUVma(xP=0.027)及纵隔淋巴结SUVma(xP=0.046)是影响本组NSCLC患者术后生存的独立预后因素,三者的相对危险度分别为2.230,2.179及1.962。结论:对于N0～N1期的NSCLC术后患者,术前PET/CT纵隔淋巴结SUVmax、TNM分期、原发病灶SUVmax均是影响患者术后生存的因素。将三者结合起来,对于指导临床尽早制定术后个体化治疗方案、延长患者生存期具有重要意义。

细胞角蛋白在子宫内膜癌淋巴结中的表达及意义

目的 :研究细胞角蛋白 (cytokeratin ,CK)在子宫内膜癌淋巴结中的表达及其意义。方法 :采用免疫组化SP法检测 5 0例子宫内膜癌患者的淋巴结 2 98枚中CK的表达。结果 :(1)在转移淋巴结中 ,CK皆呈强阳性表达 ,其阳性表达率为 10 0 %。在Ⅰ、Ⅱ、Ⅲc期无转移淋巴结中 ,CK皆呈弱阳性表达 ,其阳性表达率分别为 14 .5 %、15 .1%和 16 .4 % ,3期差异无显著性 (P >0 .0 5 ) ;(2 )Ⅰ、Ⅱ期病例的淋巴结中CK表达在肌层浸润深度、组织学类型、组织学分级 3组的组内差异无显著性 (P >0 .0 5 ) ;而淋巴管浸润组的组内差异有显著性 (P <0 .0 5 ) ;(3)Ⅰ、Ⅱ期病例的淋巴结中CK表达及其他预后因素与肿瘤复发的关系 ,淋巴结中CK表达、淋巴管浸润、术后治疗 3组的组内差异有显著性 (P <0 .0 5 ) ,而肌层浸润深度、组织学类型、组织学分级 3组的组内差异无显著性 (P >0 .0 5 ) ;(4 )对子宫内膜癌的诸预后因素如肌层浸润深度、组织学类型、组织学分级、淋巴结中CK表达、淋巴管浸润、术后治疗等进行多元回归分析 ,结果显示 :淋巴结中CK表达是Ⅰ、Ⅱ期子宫内膜癌患者复发的唯一相关因素。结论 :在无转移淋巴结中 ,CK表达与淋巴管浸润有关 ,提示可能存在淋巴结微转移 ,是Ⅰ。

胸段食管鳞癌淋巴结转移数和区域与术后放疗价值的临床研究

目的对胸段食管鳞癌根治术患者的淋巴结转移数和区域与术后放疗的疗效进行分析，评价术后放疗价值。方法选择2007年前14年内我院胸段食管癌根治术后病理诊断鳞癌、淋巴结转移阳性及无远处血道转移的N1期患者945例，其中单纯手术590例，术后放疗355例。术后3～4周开始2Gy／次放疗，中位剂量50Gy分25次5周完成。结果随访率为94．5％，随访满5年者189例。5年生存率单纯手术组和术后放疗组分别为29．6％和38．0％（χ^2=10．44，P=0．001）。分层分析术后放疗较单纯手术可提高淋巴结转移数3～5个、〉5个和仅有锁骨上区及上纵隔区淋巴结转移的5年生存率（30．5％：23．1％，χ^2=4．11，P=0．043；16．7％：8．9％，χ^2=6．87，P=0．009；45．5％：34．9％，χ^2=5．37，P=0．020），而不能提高淋巴结转移数1～2个和仅有中下纵隔及上腹部区淋巴结转移的生存率（50．7％：41．2％，χ^2=3．30，P=0．069；32．0％：27．7％，χ^2=2．22，P=0．137），但可降低锁骨上区及中上纵隔区淋巴结转移例数（15：76，χ^2=18．10，P=0．000；18：97，χ^2=26．81，P=0．000）。结论N1期胸段食管鳞癌三野根治术后放疗可提高淋巴结转移数≥3个和仅有锁骨上区及上纵隔区淋巴结转移者的生存率，并能降低锁骨上区及中上纵隔区淋巴结转移率。

CCL7 and CCL21 overexpression in gastric cancer is associated with lymph node metastasis and poor prognosis

AIM： To investigate how a complex network of CC chemokine ligands （eeLs） and their receptors influence the progression of tumor and metastasis.METHODS： In the present study, we used immunohistochemistry to examine the expression of CCL7, CCL8 and CCL21 in 194 gastric cancer samples and adjacent normal tissues. We analyzed their correlation with tumor metastasis, clinicopathologic parameters and clinical outcome.RESULTS： We found that the higher expression of CCL7 and CCL21 in cancer tissues than in normal tissues was significantly correlated with advanced depth of wall invasion, lymph node metastasis and higher tumornode metastasis stage. Moreover, Kaplan-Meier survival analysis revealed that CCL7 and CCL21 overexpression in cancer tissues was correlated with poor prognosis.CONCLUSION： These results suggest that overexpression of these two CC chemokine ligands is associ- ated with tumor metastasis and serves as a prognostic factor in patients with gastric cancer.

Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma

AIM:The prognosis of early gastric carcinoma (EGC) is generally excellent after surgery. The presence or absence of lymph node metastasis in EGC is an important prognostic factor. The survival and recurrence rates of node-negative EGC are much better than those of node-positive EGC. This study examined the factors related to lymph node metastasis in EGC to determine the appropriate treatment for EGC.METHODS: We investigated 748 patients with EGC who underwent surgery between January 1985 and December 1999 at the Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hospital. Several clinicopathologic factors were investigated to analyze their relationship to lymph node metastasis: age, sex, tumor location, tumor size, gross type, histologic type, depth of invasion, extent of lymph node dissection, type of operation,and DNA ploidy.RESULTS:Lymph node metastases were found in 75 patients (10.0%). Univariate analysis showed that male sex, tumor size larger than 2.0cm, submucosal invasion of tumor, histologic differentiation, and DNA ploidy pattern were risk factors for regional lymph node metastasis in EGC patients. However, a multivariate analysis showed that three risk factors were associated with lymph node metastasis:large tumor size, undifferentiated histologic type and submucosal invasion. No statistical relationship was found for age, sex, tumor location, gross type, or DNA ploidy in multivariate analysis. The 5-year survival rate was 94.2% for those without lymph node metastasis and 87.3% for those with lymph node metastasis, and the difference was significant (P<0.05).CONCLUSION: In patients with EGC, the survival rate of patients with positive lymph nodes is significantly worse than that of patients with no lymph node metastasis. Therefore,a standard D2 lymphadenectomy should be performed in patients at high risk of lymph node metastasis: large tumor size, undifferentiated histologic type and submucosal invasion.

Expression of G3BP and RhoC in esophageal squamous carcinoma and their effect on prognosis

AIM: To investigate the expression and significance of G3BP and RhoC proteins in esophageal squamous carcinoma (ESC). METHODS: The expression of G3BP and Rhoc proteins in 80 cases of ESC was detected by immunohistochemistry. The relationship was studied between the expression of the two proteins and tumor size, differentiation degree, TNM stage, lymph node metastasis and prognosis of ESC. RESULTS: The positive expression rate of G3BP in ESC was 71.25%; and the rate in the lymph node metastasis group was significantly higher than that in the non- lymph node metastasis group (Z = -2.283, P = 0.022), but no relations were found between G3BP expression and tumor size, differentiation degree and TNM stage (P > 0.05). The group with G3BP positive expression had shorter survival time than the group with G3BP negative expression (P = 0.000). The positive expression rate of RhoC in ESC was 66.25%; and the rate in the lymph node metastasis group was significantly higher than that in the non-lymph node metastasis group (Z = -2.115, P < 0.05), but no relations were found between RhoC expression and tumor size, differentiation degree and TNM stage (P > 0.05). The RhoC positive expression group had a shorter survival time than the RhoC negative expression group (P < 0.001. The expression of G3BP protein correlated positively with the expression of RhoC in ESC tissues (rs = 0.656, P < 0.001). CONCLUSION: The expression of G3BP and RhoC protein is closely related to the lymph node metastasis and survival in ESC patients. G3BP and RhoC proteins can be considered as predictors of prognosis in ESC patients.

Prognostic impact of dissected lymph node count on patients with node-negative gastric cancer

AIM:To investigate the long-term effect of the number of resected lymph nodes (LNs) on the prognosis of patients with node-negative gastric cancer.METHODS: Clinical data of 211 patients with gastric cancer, without nodal involvement, were analyzed retrospectively after D2 radical operation. We analyzed the relationship between the number of resected LNs with the 5-year survival, the recurrence rate and the post-operative complication rate.RESULTS: The 5-year survival of the entire cohort was 82.2%. The total number of dissected LNs was one of the independent prognostic factors. Among patients with comparable depth of invasion, the larger the number of resected LNs, the better the survival (P<0.05). A cut-point analysis provided the possibility to detect a significant survival difference among subgroups. Patients had a better long-term survival outcomes with LN counts ≥15 for pT1-2, ≥20 for pT3-4, and ≥15 for the entire cohort. The overall recurrence rate was 29.4% within 5 years after surgery. There was a statistically significant, negative correlation between the number of resected LNs and the recurrence rate (P>0.01). The post-operative complication rate was 10.9% and was not signif icantly correlated with the number of dissected LNs (P>0.05).CONCLUSION: For node-negative gastric cancer, sufficient number of dissected LNs is recommended during D2 lymphadenectomy, to improve the long-term survival and reduce the recurrence. Suitable increments of the dissected LN count would not increase the post-operative complication rate.

Effect of lymph node micrometastases on prognosis of gastric carcinoma

AIM： To evaluate the relationship between lymph node micrometastases and prognosis of patients with gastric carcinoma and to evaluate the significance of the new assessment of nodal status in determining the pN categories in the 5th edition of the UICC TNM classification.METHODS： A total of 850 lymph nodes from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenectomy were assessed by reverse transcription polymerase chain reaction assay in addition to histologic examination. Cytokeratin-20 gene marker was used in this assay.RESULTS： Routine examination by HE staining confirmed metastasis in 233 lymph nodes from 20 patients. All these 233 lymph nodes were oltokeratin-20 positive. Moreover, lymph node micrometastases were detected in an additional 67 lymph nodes in 12 of these 20 patients. Lymph node micrometastases were also detected in t0 lymph nodes from 2 of 10 patients who had no obvious metastases identified by HE staining. Totally, lymph node micrometastases were identified by the reverse transcription polymerase chain reaction assay in 77 （12.5%） lymph nodes from 14 （46.7%） patients with gastric carcinoma. Of 27 patients who underwent curative resection, 7 （25.9%） were up-staged （from Ⅰ B stage to Ⅱ stage in 1 patient, from IB stage to ⅢA stage in 1 patient, from Ⅱ stage to ⅢA stage in 1 patient, from ⅢA stage to ⅢB stage in 1 patient, from ⅢA stage to Ⅳ stage in 1 patient, from ⅢB stage to Ⅳ stage in 2 patients）. In a median follow-up of 32 （range 8-36） too, Kaplan-Meier survival analysis showed significant improvements in median survival （22.86 ± 3.17 mo, 95% CI： 16.64-29.08 mo vs 18.00 ± 7.4 mo, 95% CI： 3.33-32.67 mo） of patients with negative lymph node micrometastases over patients with positive lymph node micrometastases （log-rank, P 〈 0.05）.CONCLUSION： Lymph node micrometastases have a significant impact on the current staging system of gastric carcinoma, and are significant risk factors for prognosis of patients with gastric carcinoma.

Association of serum vascular endothelial growth factor-C and lymphatic vessel density with lymph node metastasis and prognosis of patients with gastric cancer

AIM： To investigate whether serum vascular endothelial growth factor-C （SVEGF-C）, VEGF-C, and lymphatic vessel density （LVD） in tumor tissues are related to lymph node metastasis （LNM） and prognosis in gastric cancer. METHODS： SVEGF-C levels of 80 gastric cancer patients and 20 healthy donors were examined using ELISA. VEGF-C expression and LVD were examined using immunohistochemical staining. Kaplan-Meier survival analysis was performed to determine their influence on the prognosis of the patients. RESULTS： The SVEGF-C level in gastric cancer patients （595.9 ± 201.0 ng/L） was significantly higher （P = 0.000） than controls （360.0 ± 97.4 ng/L）. Both SVEGF-C and LVD were significantly higher in poorly differentiated adenocarcinomas, T3 and T4, LNM, distant metastasis, and pTNM groups Ⅲ and Ⅳ （P = 0.000）. The sensitivity and specificity of SVEGF-C for predicting LNM were 82.8% and 81.8%, respectively （cut-off = 542.5 ng/L）. The positive expression rate of VEGF-C was significantly higher in cancerous than in normal tissues （65% vs 20%; P = 0.001）. VEGF-C expression up-regulation was significantly related to differentiation, depth of invasion, LNM, distant metastasis, and pTNM stage （P = 0.000）. LVD was 10.7 ± 3.1/200 HP in the experimental group vs 4.9 ± 1.3/200 HP in controls （P = 0.000）; LVD in cancerous tissues with and without LNM was 12.0 ± 2.7/200 HP vs 7.6 ± 0.5/200 HP, respectively （P = 0.000）. SVEGF-C and LVD were significantly higher in VEGF-C positive than in negative patients （P = 0.000）; SVEGF-C level was related to LVD （P = 0.000）. Kaplan-Meier survival analysis factors predicating poor prognosis were： SVEGF-C level （P = 0.001）, VEGF-C expression and LVD （both P = 0.000）. CONCLUSION： SVEGF-C level, VEGF-C and LVD are related to LNI and poor prognosis of patients with gastric cancer, SVEGF-C may be a biomarker for LNI in gastric cancer,

Expression of connective tissue growth factor in tumor tissues is an independent predictor of poor prognosis in patients with gastric cancer

AIM: To examine the expression of connective tissue growth factor (CTGF), also known as CCN2, in gastric carcinoma (GC), and the correlation between the expression of CTGF, clinicopathologic features and clinical outcomes of patients with GC. METHODS: One hundred and twenty-two GC patients were included in the present study. All patients were followed up for at least 5 years. Proteins of CTGF were detected using the Powervision two-step immunostaining method. RESULTS: Of the specimens from 122 GC patients analyzed for CTGF expression, 58 (58/122, 47.5%) had a high CTGF expression in cytoplasm of gastric carcinoma cells and 64 (64/122, 52.5%) had a low CTGF expression. Patients with a high CTGF expression showed a higher incidence of lymph node metastasis than those with a low CTGF expression (P = 0.032). Patients with a high CTGF expression had significantly lower 5-year survival rate than those with a low CTGF expression (27.6% vs 46.9%, P = 0.0178), especially those staging Ⅰ+Ⅱ+Ⅲ (35.7% vs 65.2%, P = 0.0027). CONCLUSION: GC patients with an elevated CTGF expression have more lymph node metastases and a shorter survival time. CTGF seems to be an independent prognostic factor for the successful differentiation of high-risk GC patients staging Ⅰ+Ⅱ+Ⅲ. Over-expression of CTGF in human GC cells results in an increased aggressive ability.

S100A4 over-expression underlies lymph node metastasis and poor prognosis in colorectal cancer

AIM:To develop lymph node metastasis(LNM)-associated biomarkers for colorectal cancer(CRC) using quantitative proteome analysis.METHODS:Differences in protein expression between primary CRC with LNM(LNM CRC) and without LNM(non-LNM CRC) were assessed using methyl esterification stable isotope labeling coupled with 2D liquid chromatography followed by tandem mass spectrometry(2D-LC-MS/MS).The relationship to clinicopathological parameters and prognosis of candidate biomarkers was examined using an independent sample set.RESULTS:Forty-three proteins were found to be differentially expressed by at least 2.5-fold in two types of CRC.S100A4 was significantly upregulated in LNM CRC compared with non-LNM CRC,which was confirmed by Western blotting,immunohistochemistry and real-time quantitative polymerase chain reaction.Further immunohistochemistry on another 112 CRC cases showed that overexpression of S100A4 frequently existed in LNM CRC compared with non-LNM CRC(P < 0.001).Overexpression of S100A4 was significantly associated with LNM(P < 0.001),advanced TNM stage(P < 0.001),increased 5-year recurrence rate(P < 0.001) and decreased 5-year overall survival rate(P < 0.001).Univariate and multivariate analyses indicated that S100A4 expression was an independent prognostic factor for recurrence and survival of CRC patients(P < 0.05).CONCLUSION:S100A4 might serve as a powerful biomarker for LNM and a prognostic factor in CRC.

ADENOSQUAMOUS LUNG CARCINOMA:CLINICAL CHARACTERISTICS,SURGICAL TREAMENT AND PROGNOSIS

Objective.The effectiveness of surgical resection of adenosquamous carcinoma of the lung remains poorly defined because of the histology’s relatively low frequency, the failure in most published series to separate adenosquamous carcinoma from the other variants of non-small cell lung carcinoma.To define the effectiveness of surgical treatment of adenosquamous carcinoma,we have retrospectively reviewed our hospital experience over a 12-year period. Methods.Retrospectively reviewed 22 cases of adenosquamous carcinoma who were surgically treated,except one patient,in the PUMCH from Jan.1985 to Aug.1997.This series constitutes the 19% of a total of 1 245 patients with all types of surgical treatment for the primary lung cancer during the same time. Results.The adenosquanous carcinoma was mostly presented in the old patients with a mean age of 60 years and mostly located in the peripheral of lung(n=20).The overall 5-year survival was 23%.Those with stage Ⅰ tumors survival was only 18%(n=13), stage Ⅱ 5%. The survival in stage Ⅲ tumors was not longer than 25 months and in stage Ⅳ survival was not longer than 12 months. Conclusion.Our results suggest that adenosquamous carcinoma of lung was a virulent tumor,which exhibited highly aggressive biological behavior with early lymph nodes metastasis(46%) and its prognosis was worse than that of both squamous cell carcinoma and adenocarcinoma.

Effects of postmastectomy radiotherapy on prognosis in different tumor stages of breast cancer patients with positive axillary lymph nodes

Objective: To explore the effects of postmastectomy radiotherapy(PMRT) on the locoregional failure-free survival(LRFFS) and overall survival(OS) of breast cancer patients under different tumor stages and with one to three positive axillary lymph nodes(ALNs). Methods: We conducted a retrospective review of 527 patients with one to three positive lymph nodes who underwent modified radical or partial mastectomy and axillary dissection from January 2000 to December 2002. The patients were divided into the T1-T2 N1 and T3-T4 N1 groups. The effects of PMRT on the LRFFS and OS of these two patient groups were analyzed using SPSS 19.0, Pearson's χ2-test, Kaplan-Meier method, and Cox proportional hazard model. Results: For T1-T2 N1 patients, no statistical significance was observed in the effects of PMRT on LRFFS [hazard ratio(HR)=0.726; 95% confidence interval(CI): 0.233-2.265; P=0.582] and OS(HR=0.914; 95% CI: 0.478-1.745; P=0.784) of the general patients. Extracapsular extension(ECE) and high histological grade were the risk factors for LRFFS and OS with statistical significance in multivariate analysis. Stratification analysis showed that PMRT statistically improved the clinical outcomes in high-risk patients [ECE(+), LRFFS: P=0.026, OS: P=0.007; histological grade III, LRFFS: P<0.001, OS: P=0.007] but not in low-risk patients [ECE(–), LRFFS: P=0.987, OS: P=0.502; histological grade I-II, LRFFS: P=0.816, OS: P=0.296]. For T3-T4 N1 patients, PMRT effectively improved the local control(HR=0.089; 95% CI: 0.210-0.378; P=0.001) of the general patients, whereas no statistical effect was observed on OS(HR=1.251; 95% CI: 0.597-2.622; P=0.552). Absence of estrogen receptors and progesterone receptors(ER/PR)(–) was an independent risk factor. Further stratification analysis indicated a statistical difference in LRFFS and OS between the high-risk patients with ER/PR(–) receiving PMRT and not receiving PMRT [ER/PR(–), LRFFS: P=0.046, OS: P=0.039]. However, PMRT had a beneficial effect on the reduction of locoregional recurrence(LRR) but not in total mortality [ER/PR(+), LRFFS: P<0.001, OS: P= 0.695] in T3-T4 N1 patients with ER/PR(+) who received endocrine therapy. Conclusion: PMRT could reduce ECE(+), histological grade III-related LRR, and total mortality of T1-T2 N1 patients. T3-T4 N1 patients with ER/PR(–) could benefit from PMRT by improving LRFFS and OS. However, PMRT could only reduce LRR but failed to improve OS for T3-T4 N1 patients with ER/PR(+) who received endocrine therapy.

Study of the Relations among Tumor Size and Axillary Lymph Nodes Involvement with the Prognosis of Patients with Breast Cancer Surgery in Shohada Hospital in Tehran, Tajrish

Facts and evidence hold out a steadily increasing prevalence of breast cancer in the mid-1940s. In most cases, the disease is discovered when the disease has reached an advanced stage, therefore, early diagnosis can significantly reduce the burden of disease. Breast cancer has some risk factors, such as tumor size and lymph node involvement. The aim of this study was to evaluate the correlation between tumor size and axillary lymph node involvement and the prognosis for patients with breast cancer has been surgery. The study population consisted of 100 patients with breast cancer surgery at Shohada Hospital of Tajrish during the last 10 years. The results suggest that lymph node involvement was significantly associated with prognosis in patients with breast cancer and in cases where the tumor size was less than 1 cm, it has no impact on the prognosis of breast cancer. Also, a family history of the disease among close relatives is an independent risk factor for poor prognosis, in patients with breast cancer in general it can be said that involvement of lymph nodes in patients with breast cancer is due to an unfavorable prognosis; but the number of lymph nodes involved and the size of the tumor did not have any effect on the prognosis.

Influence of the Number of Lymph Nodes Examined on the Prognosis of Patients with Dukes' B and C Colorectal Carcinoma

OBJECTIVE To analyze the influence of the number of lymph nodes examined on the prognosis of Dukes' B and C colorectal cancer patients.METHODS The relationship between the clinicopathologic features of 373 patients with Dukes' B and C colorectal cancer and number of the lymph nodes examined was retrospectively analyzed.The effect of the different number of nodes examined on the prognosis of the patients was appraised RESULTS The overall mean number of retrieved lymph nodes of the 373 patients with Dukes' B and C colorectal cancer was 13.71±9.38.The site and size of the tumor as well as the depth of tumor infiltration were the major reasons which influenced the number of lymph nodes retrieved.The mean number of lymph nodes examined in the colon-cancer patients was 17.51± 12.79,which was significantly more than the 11.09±6.17(P = 0.000)exam-ined in the rectal-cancer patients.The 5-year survival rate of the patients with Dukes' B large intestinal carcinoma,with fewer lymph nodes retrieved(0 to 10),was only 60.4%,while those with more lymph node retrieved(≥10)had a 5-year survival of 77.5%.So there was a significant difference between the two groups.However the number of lymph nodes examined had no effect on prognosis of the patients with Dukes' C large intestinal carcinoma.Separate analysis of the colon and rectal cancers indicated that to improve the 5-year survival rate,the number of retrieved nodes in cases with rectal cancer should be at least 9,and with colon cancer cases at least 13.CONCLUSION In order to guarantee an accuracy of tumor staging for developing a possible postoperative treatment,at least 9 lymph nodes in rec-tal cancer patients or 13 in colon cancer patients should be harvested.

Clinical characteristics and prognosis of triple-negative breast cancer

Objective： We investigated the clinical characteristics, and the prognostic factors of triple-negative breast cancer. Methods： 130 triple-negative breast cancer patients were reviewed on clinical characteristics and prognosis. All cases were lack of expression of estrogen receptor, progesterone receptor, and HER2/neu determined by immunohistochemistry. Results： 17.1% of all breast cancer patients （774 cases） were triple-negative breast cancer, and 68.9% of triple-negative breast cancer patients （91 cases） were premenopausal. 53.8% of patients （71 cases） had the tumors with T2 size, and 39.4% of them （52 patients） had lymph node metastasis. The rate of relapse in patients with lymph node metastasis was obviously higher than that in patients without lymph node metastasis （P = 0.001）. The median time of follow-up was 63 months. 33 cases relapsed and 20 patients died. 23 patients had at least two organs metastasis. The 5-year disease-free and overall survival rates were 73.8% and 85.7%. Conclusion： Triple-negative breast cancer patients commonly have high rate of multiple distant metastasis in 2-3 years after treatment. The status of lymph node is the most important prognostic factor. The triple-negative breast caner patients with lymph node metastasis have poor prognosis.

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.

Is there a relationship between length of resection and lymph-node ratio in colorectal cancer?

Background:The prognosis of colorectal cancer depends on the number of positive lymph nodes(LNþ)and the total number of lymph nodes resected(rLN).This represents the lymph-node ratio(LNR).The aim of our study is to assess how the length of the resected specimen(RL)influences the prognostic values of the LNR.Methods:We conducted a retrospective study of all the patients operated on for colorectal cancer from 2000 to 2015 at our institution.Pathology details were analysed.The total number of rLN,the number of LNþ,and the LNR were calculated and measured against the RL.The receiver-operating characteristic(ROC)curve of patients with LNþwas calculated.Results:Of the 670 patients included in our study,337 were men(50.3%)and the mean age was 69.2 years.The correlation with prognosis of the LNR is greater than that of the LNR adjusted to RL(LNR/RL),both in subjects with positive nodes(n=312)and in all cases(n=670).The LNR presents a higher prognostic value than LNR/RL and RL in patients with LNþexcept for metastatic recurrence,for which the predictive value appears slightly higher for LNR/RL.The statistical significance of the maximal divergence in Kaplan–Meier survival plots was demonstrated for the LNR(P=0.043),not for LNR/RL(P=0.373)and RL alone(P=0.314).Conclusion:An increase in RL causes an increase in the number of harvested lymph nodes without affecting the number of LNþ,thus representing a confounding factor that could alter the prognostic value of the LNR.Prospective larger-scale studies are needed to confirm these findings.