It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN)...It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) metastasis.Consequently,the indications for endoscopic resection were expanded to include such undifferentiated EGC lesions.We describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative finding.The surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative findings.This case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.展开更多
The gravest prognostic factor in early gastric cancer is lymph-node metastasis,with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treat...The gravest prognostic factor in early gastric cancer is lymph-node metastasis,with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinicpathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy,functional symptoms may still result. Physicians must strive to minimize postgastrectomy symptoms and optimize long-term quality of life after this operation.Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients.Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.展开更多
Background:The risk of lymph-node metastasis(LNM)in T1 colorectal cancer(CRC)has not been well documented in heterogeneous Western populations.This study investigated the predictors of LNM and the long-term outcomes o...Background:The risk of lymph-node metastasis(LNM)in T1 colorectal cancer(CRC)has not been well documented in heterogeneous Western populations.This study investigated the predictors of LNM and the long-term outcomes of patients by analysing T1 CRC surgical specimens and patients’demographic data.Methods:Patients with surgically resected T1 CRC between 2004 and 2014 were identified from the Surveillance,Epidemiology,and End Results(SEER)database.Patients with multiple primary cancers,with neoadjuvant therapy,or without a confirmed histopathological diagnosis were excluded.Multivariate logistic-regression analysis was used to identify the predictors of LNM.Results:Of the 22,319 patients,10.6%had a positive lymph-node status based on the final pathology(nodal category:N19.6%,N21.0%).Younger age,female sex,Asian or African-American ethnicity,poor differentiation,and tumor site outside the rectum were significantly associated with LNM.Subgroup analyses for patients stratified by tumor site suggested that the rate of positive lymph-node status was the lowest in the rectum(hazard ratio:0.74;95%confidence interval:0.63–0.86).Conclusion:The risk of LNM was potentially lower in Caucasian patients than in API or African-American patients with surgically resected T1 CRC.Regarding the T1 CRC site,the rectum was associated with a lower risk of LNM.展开更多
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 ...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.展开更多
目的:回顾性分析外侧象限乳腺癌患者乳腺原发肿瘤及腋窝淋巴结的超声特征,并构建列线图模型,为临床评估外侧象限乳腺癌患者腋窝淋巴结转移提供影像学依据。方法:回顾性分析无锡市锡山人民医院经病理证实的127例外侧象限乳腺癌患者腋窝...目的:回顾性分析外侧象限乳腺癌患者乳腺原发肿瘤及腋窝淋巴结的超声特征,并构建列线图模型,为临床评估外侧象限乳腺癌患者腋窝淋巴结转移提供影像学依据。方法:回顾性分析无锡市锡山人民医院经病理证实的127例外侧象限乳腺癌患者腋窝淋巴结及乳腺原发肿瘤的超声影像学特征。伴腋窝淋巴结转移者分入阳性组(54例),不伴腋窝淋巴结转移者分入阴性组(73例)。采用单变量和多变量Logistic回归分析,筛选淋巴结转移的危险因素。使用R语言将数据集随机分成训练集和验证集,基于训练集构建列线图预测模型,预测腋窝淋巴结转移风险,并在验证集中验证。受试者工作特征(receiver operating characteristic,ROC)曲线用于评估诊断性能,校正曲线和Hosmer-Lemeshow检验用于评估预测值与实际列线图预测值的一致性。结果:肿瘤针状边缘(OR=4.16,95%CI:1.25~13.79)和淋巴门结构不清晰(OR=19.20,95%CI:1.98~186.36)是外侧象限乳腺癌患者发生腋窝淋巴结转移的独立危险因素。据此构建预测外侧象限乳腺癌腋窝淋巴结转移的列线图模型。ROC曲线显示,训练集的曲线下面积(area under curve,AUC)为0.74(0.62~0.86),验证集AUC为0.73(0.62~0.84)。训练集和验证集的Hosmer-Lemeshow检验分别为P=0.570和P=0.552。结论:超声有助于术前外侧象限乳腺癌患者腋窝淋巴结转移情况的评估;基于Logistic回归构建的列线图预测模型具有良好的安全性、可靠性和实用性。展开更多
文摘It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) metastasis.Consequently,the indications for endoscopic resection were expanded to include such undifferentiated EGC lesions.We describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative finding.The surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative findings.This case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.
文摘The gravest prognostic factor in early gastric cancer is lymph-node metastasis,with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinicpathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy,functional symptoms may still result. Physicians must strive to minimize postgastrectomy symptoms and optimize long-term quality of life after this operation.Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients.Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.
基金supported by the National Natural Science Foundation of China[grant numbers 81860433,81860466]the Guangdong Provincial Science and Technology Plan and Jiangxi Provincial Science and Technology Plan[grant numbers 2017A020215036,20192BAB215036]+3 种基金the National Natural Science Foundation of China[Grant Number:81860433]Training Plan for Academic and Technical Young Leaders of Major Disciplines in Jiangxi Province[Grant Number:20204BCJ23021]the Key Technology Research and Development Program of Jiangxi Province[Grant Number:20202BBG73024]the Foundation for Fostering Young Scholar of Nanchang Universiy[Grant Number:PY201822].
文摘Background:The risk of lymph-node metastasis(LNM)in T1 colorectal cancer(CRC)has not been well documented in heterogeneous Western populations.This study investigated the predictors of LNM and the long-term outcomes of patients by analysing T1 CRC surgical specimens and patients’demographic data.Methods:Patients with surgically resected T1 CRC between 2004 and 2014 were identified from the Surveillance,Epidemiology,and End Results(SEER)database.Patients with multiple primary cancers,with neoadjuvant therapy,or without a confirmed histopathological diagnosis were excluded.Multivariate logistic-regression analysis was used to identify the predictors of LNM.Results:Of the 22,319 patients,10.6%had a positive lymph-node status based on the final pathology(nodal category:N19.6%,N21.0%).Younger age,female sex,Asian or African-American ethnicity,poor differentiation,and tumor site outside the rectum were significantly associated with LNM.Subgroup analyses for patients stratified by tumor site suggested that the rate of positive lymph-node status was the lowest in the rectum(hazard ratio:0.74;95%confidence interval:0.63–0.86).Conclusion:The risk of LNM was potentially lower in Caucasian patients than in API or African-American patients with surgically resected T1 CRC.Regarding the T1 CRC site,the rectum was associated with a lower risk of LNM.
文摘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.
文摘目的:回顾性分析外侧象限乳腺癌患者乳腺原发肿瘤及腋窝淋巴结的超声特征,并构建列线图模型,为临床评估外侧象限乳腺癌患者腋窝淋巴结转移提供影像学依据。方法:回顾性分析无锡市锡山人民医院经病理证实的127例外侧象限乳腺癌患者腋窝淋巴结及乳腺原发肿瘤的超声影像学特征。伴腋窝淋巴结转移者分入阳性组(54例),不伴腋窝淋巴结转移者分入阴性组(73例)。采用单变量和多变量Logistic回归分析,筛选淋巴结转移的危险因素。使用R语言将数据集随机分成训练集和验证集,基于训练集构建列线图预测模型,预测腋窝淋巴结转移风险,并在验证集中验证。受试者工作特征(receiver operating characteristic,ROC)曲线用于评估诊断性能,校正曲线和Hosmer-Lemeshow检验用于评估预测值与实际列线图预测值的一致性。结果:肿瘤针状边缘(OR=4.16,95%CI:1.25~13.79)和淋巴门结构不清晰(OR=19.20,95%CI:1.98~186.36)是外侧象限乳腺癌患者发生腋窝淋巴结转移的独立危险因素。据此构建预测外侧象限乳腺癌腋窝淋巴结转移的列线图模型。ROC曲线显示,训练集的曲线下面积(area under curve,AUC)为0.74(0.62~0.86),验证集AUC为0.73(0.62~0.84)。训练集和验证集的Hosmer-Lemeshow检验分别为P=0.570和P=0.552。结论:超声有助于术前外侧象限乳腺癌患者腋窝淋巴结转移情况的评估;基于Logistic回归构建的列线图预测模型具有良好的安全性、可靠性和实用性。
