Prediction of lymph node metastasis in early esophageal cancer

BACKGROUND Given the poor prognosis of patients with lymph node metastasis,estimating the lymph node status in patients with early esophageal cancer is crucial.Indicators that could be used to predict lymph node metastasis in early esophageal cancer have been reported in many recent studies,but no recent studies have included a review of this subject.AIM To review indicators predicting lymph node metastasis in early esophageal squamous cell carcinoma(ESCC)and early esophageal adenocarcinoma(EAC).METHODS We searched PubMed with“[early esophageal cancer(Title/Abstract)]and[lymph node(Title/Abstract)]”or“[early esophageal carcinoma(Title/Abstract)]and[lymph node(Title/Abstract)]”or“[superficial esophageal cancer(Title/Abstract)]and[lymph node(Title/Abstract)].”A total of 29 studies were eligible for analysis.RESULTS Preoperative imaging(size),serum markers(microRNA-218),postoperative pathology and immunohistochemical analysis(depth of invasion,tumor size,differentiation grade,lymphovascular invasion,neural invasion,expression of PIM-1<30%)were predictive factors for lymph node metastasis in both early ESCC and EAC.Serum markers(thymidine kinase 1≥3.38 pmol/L;cytokeratin 19 fragment antigen 21-1>3.30 ng/mL;stathmin-1)and postoperative pathology and immunohistochemical analysis(overexpression of cortactin,mixed-lineage leukaemia 2,and stanniocalcin-1)were predictive for lymph node metastasis in early ESCC.Transcription of CD69,myeloid differentiation protein 88 and toll-like receptor 4 and low expression of olfactomedin 4 were predictive of lymph node metastasis in early EAC.A total of 6 comprehensive models for early ESCC,including logistic regression model,nomogram,and artificial neural network(ANN),were reviewed.The areas under the receiver operating characteristic curve of these models reached 0.789-0.938,and the ANN performed best.As all these models relied on postoperative pathology,further models focusing on serum markers,imaging and immunohistochemical indicators are still needed.CONCLUSION Various factors were predictive of lymph node metastasis in early esophageal cancer,and present comprehensive models predicting lymph node metastasis in early ESCC mainly relied on postoperative pathology.Further studies focusing on serum markers,imaging and immunohistochemical indicators are still in need.

ScRNA-seq reveals the correlation between M2 phenotype of tumorassociated macrophages and lymph node metastasis of breast cancer

The process of lymphatic metastasis was proved to be associated with podoplanin-expressing macrophages in breast cancer(BC).This study aimed to investigate the role of the M2 phenotype of tumor-associated macrophages and mine the key M2 macrophages-related genes for lymph node metastasis in BC.We downloaded the GSE158399 dataset from the Gene Expression Omnibus(GEO)database,which includes transcriptomic profiles of individual cells from primary tumors,negative lymph nodes(NLNs),and positive lymph nodes(PLNs)of breast cancer patients.The cell subsets were identified by clustering analysis after quality control of the scRNA-seq using Seurat.The activation and migration capability of M2 macrophages were evaluated with R package“GSVA”.The key M2 macrophages-related genes were screened from the differential expressed genes(DEGs)and M2 macrophages activation and migration gene sets collected from MSigDB database.Our analysis identified three main cell types in primary tumors,NLNs,and PLNs:basal cells,luminal cells,and immune cell subsets.The further cell type classification of immune cell subsets indicated M2 macrophages accumulation in NLs and PLs.The GSVA enrichment scores for activation and migration capability were increased significantly in M2 macrophages from primary tumors than NLNs and PLNs(pvalue<0.001).Seven M2 macrophages activation-related and 15 M2 macrophages migration-related genes were significantly up-regulated in primary tumors than NLNs and PLNs.The proportion and GSVA enrichment scores for activation and migration of M2 macrophages may be potential markers for lymph node metastasis in breast cancer.Our study demonstrated that twenty-two up-regulated mRNA may be possible therapeutic targets for lymph node metastasis in breast cancer.

Nomogram based on multimodal magnetic resonance combined with B7-H3mRNA for preoperative lymph node prediction in esophagus cancer

Accurate preoperative prediction of lymph node metastasis(LNM)in esophageal cancer(EC)patients is of crucial clinical significance for treatment planning and prognosis.AIM To develop a clinical radiomics nomogram that can predict the preoperative lymph node(LN)status in EC patients.METHODS A total of 32 EC patients confirmed by clinical pathology(who underwent surgical treatment)were included.Real-time fluorescent quantitative reverse transcription-polymerase chain reaction was used to detect the expression of B7-H3 mRNA in EC tissue obtained during preoperative gastroscopy,and its correlation with LNM was analyzed.Radiomics features were extracted from multi-modal magnetic resonance imaging of EC using Pyradiomics in Python.Feature extraction,data dimensionality reduction,and feature selection were performed using XGBoost model and leave-one-out cross-validation.Multivariable logistic regression analysis was used to establish the prediction model,which included radiomics features,LN status from computed tomography(CT)reports,and B7-H3 mRNA expression,represented by a radiomics nomogram.Receiver operating characteristic area under the curve(AUC)and decision curve analysis(DCA)were used to evaluate the predictive performance and clinical application value of the model.RESULTS The relative expression of B7-H3 mRNA in EC patients with LNM was higher than in those without metastasis,and the difference was statistically significant(P<0.05).The AUC value in the receiver operating characteristic(ROC)curve was 0.718(95%CI:0.528-0.907),with a sensitivity of 0.733 and specificity of 0.706,indicating good diagnostic performance.The individualized clinical prediction nomogram included radiomics features,LN status from CT reports,and B7-H3 mRNA expression.The ROC curve demonstrated good diagnostic value,with an AUC value of 0.765(95%CI:0.598-0.931),sensitivity of 0.800,and specificity of 0.706.DCA indicated the practical value of the radiomics nomogram in clinical practice.CONCLUSION This study developed a radiomics nomogram that includes radiomics features,LN status from CT reports,and B7-H3 mRNA expression,enabling convenient preoperative individualized prediction of LNM in EC patients.

Clinical significance and characteristics of recurrent laryngeal nerve lymph node metastasis of thoracic esophageal cancer

Objective To investigate the clinical significance and characteristics of recurrent laryngeal nerve lymph node metastasis of thoracic esophageal cancer. Methods One hundred and twenty-four patients who had undergone thoracic esophageal resection with recurrent laryngealnerve lymph node dissection in our hospital from March 2007 to February 2010. All clinical data were retrospectively analysed. Results Recurrent laryngeal

A nomogram for predicting lymph node metastasis in superficial esophageal squamous cell carcinoma

Superficial esophageal squamous cell carcinoma(SESCC)is defined as carcinoma with mucosal or submucosal invasion,regardless of regional lymph node metastasis(LNM).The lymph node status is not only a key factor to determine the training strategy,but also the most important prognostic factor in esophageal cancer.In this study,we establish a clinical nomogram for predicting LNM in patients with SESCC.A predictive model was established based on the training cohort composed of 711 patients who underwent esophagectomy for SESCC from December 2009 to June 2018.A prospective cohort of 203 patients from June 2018 to January 2019 was used for validation.Favorable calibration and well-fitted decision curve analysis were conducted and good discrimination was observed(concordance index[C-index],0.860;95%confidence interval[CI],0.825-0.894)through internal validation.The external validation cohort presented good discrimination(C-index,0.916;95%CI,0.860-0.971).This model may facilitate the prediction of LNM in patients with SESCCs.

Importance of investigating high-risk human papillomavirus in lymph node metastasis of esophageal adenocarcinoma

High-risk human papillomavirus has been suggested as a risk factor for esophageal adenocarcinoma.Tumor human papillomavirus status has been reported to confer a favorable prognosis in esophageal adenocarcinoma.The size of the primary tumor and degree of lymphatic spread determines the prognosis of esophageal carcinomas.Lymph node status has been found to be a predictor of recurrent disease as well as 5-year survival in esophageal malignancies.In human papillomavirus driven cancers,e.g.cervical,anogenital,head and neck cancers,associated lymph nodes with a high viral load suggest metastatic lymph node involvement.Thus,human papillomavirus could potentially be useful as a marker of micro-metastases.To date,there have been no reported studies regarding human papillomavirus involvement in lymph nodes of metastatic esophageal adenocarcinoma.This review highlights the importance of investigating human papillomavirus in lymph node metastasis of esophageal adenocarcinoma based on data derived from other human papillomavirus driven cancers.

Synaptophysin-like 2 expression correlates with lymph node metastasis and poor prognosis in colorectal cancer patients

BACKGROUND Colorectal cancer(CRC)is one of the most common and fatal cancers worldwide.Synaptophysin-like 2(SYPL2)is a neuroendocrine-related protein highly expressed in skeletal muscle and the tongue.The involvement of SYPL2 in CRC,including its level of expression and function,has not been evaluated.AIM To evaluate the correlations of SYPL2 expression with lymph node metastasis(LNM)and prognosis in patients with CRC.METHODS The levels of expression of SYPL2 in CRC and normal colorectal tissues were analyzed in multiple public and online databases.The associations between clinical variables and SYPL2 expression were evaluated statistically,and the associations between SYPL2 expression and prognosis in patients with CRC were analyzed using the Kaplan-Meier method and univariate/multivariate Cox regression analyses.SYPL2 expression was assessed in 20 paired CRC tissue and adjacent normal colorectal tissue samples obtained from Fuyang People’s Hospital,and the associations between SYPL2 expression and the clinical characteristics of these patients were investigated.Correlations between the levels of expression of SYPL2 and key targeted genes were determined by Pearson’s correlation analysis.The distribution of immune cells in these samples was calculated using the CIBERSORT algorithm.Gene set enrichment analysis(GSEA)was performed to evaluate the biofunction and pathways of SYPL2 in CRC.RESULTS SYPL2 expression was significantly lower in CRC tissue samples than in normal colorectal tissue samples(P<0.05).High SYPL2 levels in CRC tissues correlated significantly with LNM(P<0.05)and a poorer patient prognosis,including significantly shorter overall survival(OS)[hazard ratio(HR)=1.9,P<0.05]and disease-free survival(HR=1.6,P<0.05).High SYPL2 expression was an independent risk factor for OS in both univariate(HR=2.078,P=0.014)and multivariate(HR=1.754,P=0.018)Cox regression analyses.In addition,SYPL2 expression correlated significantly with the expression of KDR(P<0.0001,r=0.47)and the BRAFV600E mutation(P<0.05).Higher SYPL2 expression was associated with the enrichment of CD8 T-cells and M0 macrophages in the tumor microenvironment.GSEA revealed that SYPL2 was associated with the regulation of epithelial cell migration,vasculature development,pathways in cancer,and several vital tumor-related pathways.CONCLUSION SYPL2 expression was lower in CRC tissue than in normal colorectal tissue.Higher SYPL2 expression in CRC was significantly associated with LNM and poorer survival.

Cyclooxygenase-2 expression after preoperative chemoradiotherapy correlates with more frequent esophageal cancer recurrence

AIM： To investigate the relationship between cycloo- xygenase-2 （COX-2）, and vascular endothelial growth factor （VEGF）, and to determine the clinical significance of this relationship in esophageal cancer patients undergoing chemoradiotherapy （CRT）. METHODS： Immunohistochemical staining was used to evaluate COX-2 and VEGF expression in 40 patients with histologically-confirmed esophageal squamous carcinoma （ESCC） who were undergoing preoperative CRT. RESULTS： Fourteen out of 40 ESCC patients showed a pathological complete response （CR） after CRT. COX-2 and VEGF protein expressions were observed in the cytoplasm of 17 and 13 tumors, respectively, with null expression in 9 and 13 tumors, respectively. COX-2 expression was strongly correlated with VEGF expression （P 〈 0.05）. There were also significant associations between COX-2 expression, tumor recurrence, and lymph-node involvement （P = 0.0277 and P = 0.0095, respectively）. COX-2 expression and VEGF expression had significant prognostic value for disease-free survival （log-rank test; P = 0.0073 and P = 0.0341, respectively）, but not for overall survival, as assessed by univariate analysis. expression correlates with VEGF expression and might be a useful prognostic factor for more frequent tumor recurrence in ESCC patients undergoing neoadjuvant CRT. These findings support the use of anti-angiogenic COX-2 inhibitors in the treatment of ESCC.

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.

Nomograms and prognosis for superficial esophageal squamous cell carcinoma

In recent years,endoscopic resection,particularly endoscopic submucosal dis-section,has become increasingly popular in treating non-metastatic superficial esophageal squamous cell carcinoma(ESCC).In this evolving paradigm,it is crucial to identify factors that predict higher rates of lymphatic invasion and poorer outcomes.Larger tumor size,deeper invasion,poorer differentiation,more infiltrative growth patterns(INF-c),higher-grade tumor budding,positive lymphovascular invasion,and certain biomarkers have been associated with lymph node metastasis and increased morbidity through retrospective reviews,leading to the construction of comprehensive nomograms for outcome prediction.If validated by future prospective studies,these nomograms would prove highly applicable in guiding the selection of treatment for superficial ESCC.

Detection of D2-40 monoclonal antibody-labeled lymphatic vessel invasion in esophageal squamous cell carcinoma and its clinicopathologic significance

Objective： This study aims to investigate the clinicopathologic significance of lymphatic vessel invasion （LVI） labeled by D2-40 monoclonal antibody in esophageal squamous cell carcinoma （ESCC）. Methods： Immunohistochemical assay was used to detect the expression of D2-40 and LVI in 107 ESCC patients. Then, the correlation between the clinicopathologic feature and the overall survival time of the patients was analyzed. Results： The lymph node metastasis rates were 70% and 21% in the LVI-positive and LVI-negative groups, respectively. The nodal metastasis rate was higher in the LVI-positive group than in the LVI-negative group. Multivariate regression analysis showed that LVI was related to nodal metastasis （P〈0.001）. The median survival time of the patients was 26 and 43 months in the LVI-positive and LVI-negative groups, respectively. Mthough univariate regression analysis showed significant difference between the two groups （P=0.014）, multivariate regression analysis revealed that LVI was not an independent prognostic factor for overall survival in the ESCC patients （P=0.062）. Lymphatic node metastasis （P=0.031）, clinical stage （P=0.019）, and residual tumor （P=0.026） were the independent prognostic factors. Conclusion： LVI labeled by D2-40 monoclonal antibody is a risk factor predictive of lymph node metastasis in ESCC patients.

Thoracic para-aortic lymph node recurrence in patients with esophageal squamous cell carcinoma:A propensity score-matching analysis

BACKGROUND Thoracic para-aortic lymph node(TPLN)recurrence in esophageal squamous cell carcinoma(ESCC)is rare and its impact on survival is unknown.We studied survival in patients with ESCC who developed TPLN recurrence.AIM To study the survival in patients with ESCC who developed TPLNs recurrence.METHODS Data were collected retrospectively for 219 patients who had undergone curative surgery for ESCC during January 2012 to November 2017 and who developed recurrences(36.29%of 604 patients who had undergone curative surgeries for ESCC).The patients were classified into positive(+)and negative(-)TPLN metastasis subgroups.We also investigated TPLN recurrence in 223 patients with ESCC following definitive chemoradiotherapy during 2012-2013.Following propensity score matching(PSM)and survival estimation,factors predictive of overall survival(OS)were explored using a Cox proportional hazards model.RESULTS Among the patients with confirmed recurrence,18 were TPLN(+)and 13 developed synchronous distant metastases.Before PSM,TPLN(+)was associated with worse recurrence-free(P=0.00049)and OS[vs TPLN(-);P=0.0027],whereas only the intergroup difference in recurrence-free survival remained significant after PSM(P=0.013).The Cox analysis yielded similar results.Among the patients who had received definitive chemoradiotherapy,3(1.35%)had preoperative TPLN enlargement and none had developed recurrences.CONCLUSION TPLN metastasis is rare but may be associated with poor survival.

中老年2型糖尿病伴甲状腺乳头状癌淋巴结转移的相关因素分析

目的探讨中老年2型糖尿病患者伴甲状腺乳头状癌发生淋巴结转移的影响因素。方法纳入2018年7月到2020年10月在郑州大学第一附属医院住院且临床资料完整的2型糖尿病合并甲状腺乳头状癌病例213例,收集患者一般资料及检验检查结果,根据淋巴结转移与否分为转移组和非转移组,对比两组的临床资料情况,非条件Logistic回归模型进行危险因素分析。结果单因素统计分析显示两组间性别、乳酸脱氢酶、超氧化物歧化酶、TAP、肿瘤位置、肿瘤直径、彩超分级差异有统计学意义(P<0.05),两组间超氧化物歧化酶的差异进一步进行组内分析,淋巴结转移组的超氧化物歧化酶水平较正常水平偏低,差异有统计学意义(P<0.0167);Logistic回归分析结果显示性别、TAP、肿瘤位置是淋巴结转移的影响因素。结论中老年2型糖尿病伴甲状腺乳头状癌的男性患者、TAP升高及肿瘤位于双侧者更易出现淋巴结转移。

结肠癌组织中CXCR2的临床表达意义

目的探讨结肠癌组织内CXC趋化因子受体2(CXCR2)的临床表达意义。方法选取73例结肠癌患者作为研究对象,所有患者均于手术中采集肿瘤组织及癌旁组织,开展免疫组织化学法检测组织中CXCR2表达。比较肿瘤组织与癌旁组织内CXCR2表达差异;分析不同CXCR2表达患者年龄、性别、体质量指数、肿瘤分期、淋巴结转移、分化程度、肿瘤直径等基础资料间差异;随访3年,比较不同CXCR2表达患者远期肿瘤复发转移情况。结果肿瘤组织TIM-3阳性表达率高于癌旁组织,差异有统计学意义(P<0.05)。肿瘤分期Ⅲ~Ⅳ期、有淋巴结转移、低分化程度、肿瘤直径≥3 cm患者TIM-3表达阳性率高于肿瘤分期Ⅰ~Ⅱ期、无淋巴结转移、中高分化程度、肿瘤直径<3 cm患者,差异有统计学意义(P<0.05)。随访3年,73例患者复发转移率为35.62%(26/73);CXCR2阳性表达组复发转移率高于CXCR2阴性表达组,差异有统计学意义(P<0.05)。结论CXCR2在结肠癌组织内阳性表达率较高,与肿瘤分期、肿瘤直径、分化程度密切相关,且CXCR2阳性表达患者易伴有淋巴结转移,预后更差,可作为评估肿瘤侵袭及预后的重要参考指标。

Lymphatic spreading and lymphadenectomy for esophageal carcinoma

Esophageal carcinoma(EC) is a highly lethal malignancywith a poor prognosis. One of the most important prognostic factors in EC is lymph node status. Therefore, lymphadenectomy has been recognized as a key that influences the outcome of surgical treatment for EC. However, the lymphatic drainage system of the esophagus, including an abundant lymph-capillary network in the lamina propria and muscularis mucosa, is very complex with cervical, mediastinal and celiac node spreading. The extent of lymphadenectomy for EC has always been controversial because of the very complex pattern of lymph node spreading. In this article, published literature regarding lymphatic spreading was reviewed and the current lymphadenectomy trends for EC are discussed.

2023年ESMO会议食管癌外科治疗相关研究热点

2023年欧洲肿瘤内科学会(European Society for Medical Oncology,ESMO)大会上食管癌外科治疗相关的研究有14项,涵盖新辅助免疫治疗的不同方案以及新辅助治疗的疗效评价方法和安全性等。同时,对于新辅助治疗后达到临床完全缓解的患者是否可以避免手术治疗,来自荷兰的一项研究也报道了中期随访结果。在食管癌淋巴结转移机制、吻合口瘘预测因子及新辅助免疫治疗疗效的分子机制研究方面也取得一定的进展。本次大会也有涉及针对接受食管癌手术治疗的患者围手术期营养支持的价值的相关研究。本文拟对这些研究进行概述,以勾勒出本次大会上食管癌外科相关的研究热点。

Effects of extended lymphadenectomy and postoperative chemotherapy on node-negative gastric cancer

AIM:To investigate the effects of extended lymphadenectomy and postoperative chemotherapy on gastric cancer without lymph node metastasis.METHODS:Clinical data of 311 node-negative gastric cancer patients who underwent potentially curative gastrectomy with more than 15 lymph nodes resected,from January 2002 to December 2006,were analyzed retrospectively.Patients with pT4 stage or distant metastasis were excluded.We analyzed the relationship between the D2 lymphadenectomy and the 5-year survival rate among different subgroups stratified by clinical features,such as age,tumor size,tumor location and depth of invasion.At the same time,the relationship between postoperative chemotherapy and the5-year survival rate among different subgroups were also analyzed.RESULTS:The overall 5-year survival rate of the entire cohort was 63.7%.The 5-year survival rate was poor in those patients who were:(1)more than 65 years old;(2)with tumor size larger than 4 cm;(3)with tumor located in the upper portion of the stomach;and(4)with pT3 tumor.The survival rate was improved significantly by extended lymphadenectomy only in patients with pT3 tumor(P=0.019),but not in other subgroups.Moreover,there was no significant difference in survival rate between patients with and without postoperative chemotherapy among all of the subgroups(P>0.05).CONCLUSION:For gastric cancer patients without lymph node metastasis,extended lymphadenectomy could improve the survival rate of those who have pT3-stage tumor.However,there was no evidence of a survival benefit from postoperative chemotherapy alone.

乳腺癌组织中CNN2、ANKRD22表达水平与临床病理特征的关系研究

目的分析乳腺癌组织中钙调蛋白2(CNN2)、锚蛋白重复结构域22(ANKRD22)的表达水平与临床病理特征的关系。方法选择南通大学附属海安医院2018年1月至2023年4月收治的90例拟进行手术切除治疗的乳腺癌患者作为研究对象,收集乳腺癌组织及癌旁正常组织,使用实时荧光定量聚合酶链反应(PCR)检测CNN2、ANKRD22在乳腺癌组织及癌旁正常组织中的表达水平,观察不同病理特征的乳腺癌患者乳腺癌组织中CNN2、ANKRD22表达水平的差异,分析乳腺癌组织中CNN2、ANKRD22表达水平与临床病理特征(肿瘤最大径、病理分期、分化程度)的关系及对腋窝淋巴结转移的预测效能。结果乳腺癌组织CNN2、ANKRD22表达水平均明显高于癌旁正常组织(P<0.05)。CNN2、ANKRD22在不同肿瘤最大径、病理分期、分化程度的乳腺癌组织中的表达水平比较,差异均有统计学意义(P<0.05)。随着乳腺肿瘤最大径增加、病理分期升高和分化程度减小,乳腺癌组织中CNN2、ANKRD22的表达水平依次升高(P<0.05)。相关性分析结果显示,乳腺癌组织CNN2、ANKRD22表达水平与肿瘤最大径、病理分期呈正相关(r=0.427、0.316,P<0.05;r_(s)=0.452、0.357,P<0.05),与分化程度呈负相关(r_(s)=-0.514、-0.463,P<0.05);乳腺癌伴腋窝淋巴结转移患者乳腺癌组织中CNN2、ANKRD22表达水平高于不伴腋窝淋巴结转移患者(P<0.05);受试者工作特征曲线分析结果显示,乳腺癌组织中CNN2联合ANKRD22预测腋窝淋巴结转移的曲线下面积为0.905(95%CI:0.780~0.989)。结论乳腺癌组织中CNN2、ANKRD22的表达水平明显升高,与临床病理特征密切相关,二者联合预测腋窝淋巴结转移的效能较好,有助于评估病情,指导诊治。

子宫内膜癌组织中ZEB2和IGF1R表达情况及其与患者淋巴结转移及预后的关系

目的探讨E盒结合锌指蛋白2(ZEB2)和胰岛素样生长因子1受体(IGF1R)在子宫内膜癌组织中的表达情况及其与淋巴结转移及预后的关系。方法选取2018年6月至2020年6月邯郸市中心医院收治的137例行手术治疗的子宫内膜癌患者作为研究对象,收集患者在手术过程中切除的癌组织及癌旁组织。采用免疫组化方法检测组织中ZEB2和IGF1R的表达情况,进一步分析患者的病理特征与ZEB2和IGF1R表达情况的关系及不同临床特征与淋巴结转移的关系。进行定期随访,根据随访结果采用Kaplan-Meier法分析患者预后生存情况,采用Cox回归模型进行患者预后不良的多因素分析。结果子宫内膜癌组织中ZEB2和IGF1R阳性表达率均高于癌旁组织(P<0.05)。子宫内膜癌组织中ZEB2和IGF1R表达水平与与国际妇产科联盟(FIGO)分期、淋巴结是否转移有关(P<0.05)。淋巴结转移情况与肿瘤直径、FIGO分期有关(P<0.05)。子宫内膜癌组织ZEB2阳性表达患者3年生存率低于ZEB2阴性表达患者(P<0.05),子宫内膜癌组织IGF1R阳性表达患者3年生存率低于IGF1R阴性表达患者(P<0.05)。FIGO分期、淋巴结转移、ZEB2和IGF1R阳性表达均为子宫内膜癌患者预后不良的影响因素(P<0.05)。结论与癌旁组织比较,子宫内膜癌组织中ZEB2和IGF1R阳性表达率较高,且与患者的FIGO分期、淋巴结转移情况有关。

2型糖尿病合并甲状腺癌患者预后的高危因素分析

目的探究2型糖尿病(T2DM)合并甲状腺癌患者预后的相关因素。方法回顾性分析T2DM合并甲状腺癌患者共98例的临床资料,全部患者均行手术,术后均随访1年,统计其生存、死亡率;将生存的患者划入预后良好组,将死亡的患者划入预后不良组,并收集全部患者的年龄、性别等资料,统计影响T2DM合并甲状腺癌患者预后的相关因素。结果98例T2DM合并甲状腺癌患者中,生存75例,生存率为76.53%(75/98),死亡23例,死亡率为23.47%(23/98)。单因素分析显示:年龄、糖尿病病程、淋巴结转移、临床分期与T2DM合并甲状腺癌患者预后有关,差异有统计学意义(P<0.05);Logistic回归分析显示:年龄>60岁、糖尿病病程>5年、有淋巴结转移、Ⅲ~Ⅳ期为T2DM合并甲状腺癌患者预后不良的独立危险因素(P<0.05)。结论年龄>60岁、糖尿病病程>5年、有淋巴结转移、Ⅲ~Ⅳ期是影响T2DM合并甲状腺癌患者预后的因素,对此临床需予以高度重视。