Relationship between Expression of Vascular Endothelial Growth Factor and Cervical Lymph Node Metastasis in Papillary Thyroid Cancer: A Meta-analysis

The aim of the present study was to examine the relationship between the protein expression of vascular endothelial growth factor（VEGF） and lymph node metastasis（LNM） in papillary thyroid cancer（PTC）. VEGF-related articles that had been published until August 2016 were searched from the Pub Med, EMBASE, and MEDLINE to identify the risk factors of LNM in PTC. Rev Man 5.3 software was used for the meta-analysis. Finally, 9 articles met the inclusion criteria and were included in our meta-analysis. LNM was found to be present in 176 of 318 patients（57.8%） with high VEGF expression and in 71 of 159 patients（47.0%） with low VEGF expression. The overall OR was 2.81（95% confidence interval, 1.49–5.29）. LNM occurred more frequently in patients with high VEGF expression than in those with low VEGF expression（P=0.001）. Heterogeneity was markedly decreased in the subgroup analyses of LNM in terms of the patients＇ country of origin and the detection methods. Our meta-analysis concluded that the VEGF protein expression is associated with LNM in PTC.

Clinical and Sonographic Assessment of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

The purpose of this study was to assess the differences in clinical and sonographic features of papillary thyroid carcinoma（PTC） between cervical lymph node metastatic（CLNM） and nonmetastatic groups.Clinical data of PTC patients（414 patients with 624 malignant nodules） who underwent a preoperative ultrasonography and surgery between June 2010 and March 2015 at Renmin Hospital of Wuhan University were retrospectively analyzed.Clinical factors,preoperative ultrasound features and the final pathological findings were obtained.The differences in the sonographic features of PTC between the CLNM group and the non-CLNM group were analyzed.There were 187 CLNM and 227 non-CLNM patients.The median age at the diagnosis of this cohort was 45.4 years old（ranging from 18 to 77 years）.Ultrasonographic parameters that were significantly associated with CLNM [OR=2.569（1.502,4.393）,P〈0.001）] were as follows：the mulifocality of the nodules,size over 2 cm,the presence of microcalcifications,the distance ratio（DR） pattern showing the contact of the nodules with the thyroid capsule,and the extracapsular spread of the nodules.No significant differences in age,gender,thyroid stimulating hormone（TSH） levels and other ultrasonography parameters were found between the CLNM and the non-CLNM groups.Therefore,our results suggest that a larger size,microcalcifications,mulifocality,and the DR pattern showing the contact of the nodules with the thyroid capsule and extracapsular spread are significantly more indicative of CLNM in PTC.

Establishment of Risk Prediction Model and Nomogram for Lymph Node Metastasis of Cervical Cancer: Based on SEER Database

Objective: To predict the risk factors of lymph node metastasis in cervical cancer by using large sample clinical data, and to construct and verify the nomogram for predicting lymph node metastasis. Methods: A total of 5940 patients with cervical cancer from 2004 to 2015 in the National Cancer Institute Surveillance Epidemiology and End Results database were retrospectively screened and randomly assigned to training group (n = 4172) and validation group (n = 1768). Multivariate Logistic regression analysis was used, and the optimal model was selected according to AIC or BIC and likelihood ratio test, and a nomogram was drawn. The accuracy and robustness of the prediction model were evaluated in three aspects: discrimination, calibration and clinical net benefit. Results: The prediction model based on race, tumor tissue differentiation degree, tumor histopathological type, distant metastasis of tumor, tumor diameter and other risk factors was successfully established and a nomogram was constructed. The AUCs of training group and validation group were: 0.736 and 0.714, respectively. And the p-values of the Hosmer-Lemeshow test were 0.28 and 0.11, respectively. The calibration curve was in good agreement with the ideal curve. It had high accuracy and applicability after internal verification. Conclusion: A prediction model is constructed based on the risk factors of lymph node metastasis of cervical cancer. The nomogram has a good effective prediction and can provide a theoretical basis for clinicians to assess the disease quickly before surgery.

Study on the Influencing Factors of Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

Objective:To investigate the influencing factors of the cervical lymph node metastasis in papillary thyroid microcarcinoma(PTMC)and to provide a theoretical basis for cervical lymph node dissection.Methods:A total of 80 PTMC patients treated in the Department of Breast and Thyroid Surgery of our Hospital from January 2017 to January 2018 were selected in the study.All the patients accepted the first surgical treatment and were confirmed by pathology.The clinical data of all PTMC patients were retrospectively analyzed,and the related factors such as gender,age,number of primary lesions,tumor diameter and extrathyroidal invasions were analyzed.The factors that actually affected the lymph node metastasis of PTMC patients were explored.Results:All patients underwent prophylactic central lymph node dissection.Lymph node metastasis occurred in 26 patients in the central region and in 13 patients in the lateral neck region.The rate of lymph node metastasis in the central region of men was 41.18%,and the rate of lymph node metastasis in the lateral neck region was 23.53%,which were significantly higher than that of women's 30.16%and 14.29%.The differences were statistically significant(P<0.05).The regional metastasis rate of the patients of≤45 years was 45.83%,and the lateral neck region metastasis rate was 20.83%,which were significantly higher than those of patients>45 years old(12.50%,9.38%)and the differences were statistically significant(P<0.05).The lymph node metastasis rate in the central region and in the lateral neck region of tumor diameter<0.5 cm were 27.27%and 9.09%respectively,which were significantly lower than those of the tumor diameter 0.5-1.0 cm(38.89%,25.00%)(P<0.05).The rate of lymph node metastasis in the central region of single focus was 20.37%,which was significantly lower than that of 57.69%in the multifocal lesions;the rate of lymph node metastasis in the cervical region of the single lesion was 11.11%,which was significantly lower than 26.92%in the multifocal area;the differences were statistically significant(P<0.05).The metastasis rate of the patients with extrathyroidal invasions in the central area was 60.00%,which is significantly higher than that without extrathyroidal invasions(30.67%).About the tumor neck invasion of the lateral neck region,the lymph node metastasis rate of the patients with extrathyroidal invasions was 40.00%,which was significantly higher than that without extrathyroidal invasions(14.67%).The differences were statistically significant(P<0.05).Logistic regression analysis showed that gender and tumor size were independent influencing factors of lymph node metastasis in the central and lateral neck regions(P<0.05).Conclusion:Young,male,multifocal,tumor diameter 0.5-1.0 cm and extrathyroidal invasions are risk factors for cervical lymph node metastasis in patients with PTMC.Gender and tumor size are independent factors affecting central/lateral cervical lymph node metastasis in PTMC patients.

Sentinel lymph node identification in patients with early stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy

Background In general,sentinel lymph node (SLN) can reflect the whole state of the entire drainage area. The present study evaluated the clinical significance of sentinel lymph node identification in the treatment of early stage cervical cancer.Methods Twenty-eight patients with early stage (Ia-IIa) cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy were included in this study. At two locations 8 hours before operation,0.4 ml 37 Mbq technicium-99 labeled dextran was injected intracervically. After that,preoperative lymphoscintigraphy was performed to detect SLNs. During the operation,lymph nodes were detected ex vivo by a γ-counter to identify SLNs. The samples of SLNs and non-SLNs were used for pathological examination separately and compared with the final results. Results SLNs were identified in 27 of 28 (96.4%) patients. A total of 123 SLNs were identified from 814 nodes. Six patients had altogether 11 positive lymph nodes,which were all SLNs. No patient had false-negative sentinel node. Conclusion SLNs can successfully predict the lymphatic metastasis in patients with cervical cancer. The clinical validity of this technique should be evaluated prospectively.

Elective neck dissection in oral squamous cell carcinoma of the upper maxilla:necessary?

Aim:Surgical treatment of clinically negative neck in maxillary squamous cell carcinoma(SCC)of the upper jaw is controversial.The purpose of this systematic review was to define the incidence of cervical metastasis and to assess if elective neck dissection is justified when the neck is not primarily affected.Methods:An electronic literature search was conducted in several databases,including MEDLINE,EMBASE,and Cochrane Central databases,for articles written in English.Results:Twenty-eight articles were included in the review.The overall cervical metastases rate was 33%and the total initial cervical metastases rate was 16%.Interestingly,the author found that 71%of patients with cervical metastases from maxillary SCC carcinoma were T3/T4 stage.Conclusion:This review shows the need for a change in the management of the N0 neck in SCC arising in the maxillary alveolus and hard palate.Elective neck dissection should be performed in patients with T3/T4 tumours with clinic or radiographic negative necks(N0c).