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.

Critical prognostic value of the log odds of negative lymph nodes/tumor size in rectal cancer patients

BACKGROUND The number of negative lymph nodes(NLNs)and tumor size are associated with prognosis in rectal cancer patients undergoing surgical resection.However,little is known about the prognostic significance of the NLN count after adjusting for tumor size.AIM To assess the prognostic impact of the log odds of NLN/tumor size(LONS)in rectal cancer patients.METHODS Data of patients with stage I–III rectal cancer were extracted from the Surveillance,Epidemiology,and End Results Program database.These patients were randomly divided into a training cohort and a validation cohort.Univariate and multivariate Cox regression analyses were used to determine the prognostic value of the LONS.The optimal cutoff values of LONS were calculated using the"X-tile"program.Stratified analysis of the effect of LONS on cancer-specific survival(CSS)and overall survival(OS)were performed.The Kaplan-Meier method with the log-rank test was used to plot the survival curve and compare the survival data among the different groups.RESULTS In all,41080 patients who met the inclusion criteria were randomly divided into a training cohort(n=28775,70%)and a validation cohort(n=12325,30%).Univariate and multivariate analyses identified the continuous variable LONS as an independent prognostic factor for CSS[training cohort:Hazard ratio(HR)=0.47,95%confidence interval(CI):0.44–0.51,P<0.001;validation cohort:HR=0.46,95%CI:0.41-0.52,P<0.001]and OS(training cohort:HR=0.53,95%CI:0.49-0.56,P<0.001;validation cohort:HR=0.52,95%CI:0.42-0.52,P<0.001).The Xtile program indicated that the difference in CSS was the most significant for LONS of-0.8,and the cutoff value of-0.4 can further distinguish patients with a better prognosis in the high LONS group.Stratified analysis of the effect of the categorical variable LONS on CSS and OS revealed that LONS was also an independent predictor,independent of pN stage,pT stage,tumor-node-metastasis stage,site,age,sex,the number of examined lymph nodes,race,preoperative radiotherapy and carcinoembryonic antigen level.CONCLUSION LONS is associated with improved survival of rectal cancer patients independent of other clinicopathological factors.

THE PROGNOSIS SIGNIFICANCE OF CATHEPSIN-D EXPRESSIONIN THE DIFFERENT LOCATIONS IN AXILLARY NODES NEGATIVE CARCINOMA

Objective: The aim of this study was to investigate Cathepsin-D (Cath-D) expression in different location and its relationship with prognosis in the axillary lymph nodes negative (ANN) breast cancer patients. Methods: Cath-D expression in 192 cases of breast carcinoma were examined by immunohistochemistry. Depending on different parts of expression, three evaluating methods were used, compared and analysed. Results: The positive rate of Cath-D expression in ANN breast cancer with poor prognosis group and axillary nodes positive (ANP) group were significantly higher than that in ANN breast cancer with good prognosis group (x 2=23.20,P<0.01), while there was no significant difference between ANP group and ANN with poor prognosis group (x 2=0.19,P>0.05). Cath-D expression in stromal cells had no statistical difference among the three groups (x}2=1.56,P>0.05). When the Cath-D expression in cancer and stromal cells were counted into the positive rate, it was near the same (u 1=0.47,u 2=1.41,P>0.05). Conclusion: These results suggest that Cath-D expression is one of the powerful prognostic markers in ANN breast cancer. It’s a reliable, practical, and convenient method to observe and evaluate Cath-D expression in cancer cells.

Feasibility of sentinel lymph node biopsy omission after integration of ^(18)F-FDG dedicated lymph node PET in early breast cancer: a prospective phase II trial

Objective:Sentinel lymph node biopsy(SLNB)is currently the standard of care in clinically node negative(cN0)breast cancer.The present study aimed to evaluate the negative predictive value(NPV)of 18F-FDG dedicated lymph node positron emission tomography(LymphPET)in cN0 patients.Methods:This was a prospective phase II trial divided into 2 stages(NCT04072653).In the first stage,cN0 patients underwent axillary LymphPET followed by SLNB.In the second stage,SLNB was omitted in patients with a negative preoperative axillary assessment after integration of LymphPET.Here,we report the results of the first stage.The primary outcome was the NPV of LymphPET to detect macrometastasis of lymph nodes(LN-macro).Results:A total of 189 patients with invasive breast cancer underwent LymphPET followed by surgery with definitive pathological reports.Forty patients had LN-macro,and 16 patients had only lymph node micrometastasis.Of the 131 patients with a negative LymphPET result,16 patients had LN-macro,and the NPV was 87.8%.After combined axillary imaging evaluation with ultrasound and LymphPET,100 patients were found to be both LymphPET and ultrasound negative,9 patients had LN-macro,and the NPV was 91%.Conclusions:LymphPET can be used to screen patients to potentially avoid SLNB,with an NPV>90%.The second stage of the SOAPET trial is ongoing to confirm the safety of omission of SLNB according to preoperational axillary evaluation integrating LymphPET.

Characteristics of lymph node stations/basins metastasis and construction and validation of a preoperative combination prediction model that accurately excludes lymph node metastasis in early gastric cancer

Objective:To explore the candidate indications for function-preserving curative gastrectomy and sentinel lymph node navigation surgery in early gastric cancer(EGC).Methods:The clinicopathological data of 561 patients with EGC who underwent radical gastrectomy for gastric cancer at Peking University Cancer Hospital from November 2010 to November 2020 with postoperative pathological stage pT1 and complete examination data,were collected.Pearson’s Chi-square test was used and binary logistic regression was employed for univariate and multivariate analyses.Combined analysis of multiple risk and protective factors for lymph node metastasis(LNM)of EGC was performed.A negative predictive value(NPV)combination model was built and validated.Results:LNM occurred in 85 of 561 patients with EGC,and the LNM rate was 15.15%.NPV for LNM reached 100%based on three characteristics,including ulcer-free,moderately well differentiation and patient<65years old or tumor located at the proximal 1/3 of the stomach.Regarding lymphatic basin metastasis,multivariate analysis showed that the metastatic proportion of the left gastric artery lymphatic basin was significantly higher in male patients compared with female patients(65.96%vs.38.89%,P<0.05).The proportion of right gastroepiploic artery lymphatic basin metastasis in patients with a maximum tumor diameter>2 cm was significantly greater than that noted in patients with a maximum tumor diameter≤2 cm(60.78%vs.28.13%,P<0.05).Conclusions:Characteristics of lymph node stations/basins metastasis will facilitate precise lymph node resection.The NPV for LNM reaches 100%based on the following two conditions:young and middle-aged EGC patients,well-differentiated tumors,and without ulcers;or well-differentiated tumors,without ulcers,and tumors located in the proximal stomach.These findings can be used as the recommended indications for functionpreserving curative gastrectomy and sentinel lymph node navigation surgery.

Prognostic value of negative lymph node count in patients with jejunoileal neuroendocrine tumors

A negative lymph node(NLN)count has been shown to have a significant impact on the prognosis of many types of cancer.However,its prognostic value for jejunoileal neuroendocrine tumors(NETs)remains unclear.In this study,we investigated the prognostic value of NLN count in patients with resected jejunoileal NETs diagnosed between 1988 and 2014.The data were retrieved from the Surveillance,Epidemiology and End Results database.The X-tile program was used to determine the cutoff value of the NLN count.Univariate and multivariate Cox proportional hazards models were used to assess the prognostic value of NLN count on survival.Harrell concordance index was used to compare the prognostic validity of NLN count with 2 current prognostic systems.The optimal cutoff point of the NLN count was 8.Kaplan-Meier analysis revealed a progressively worse overall survival(OS)with an NLN count≤8 compared with an NLN count>8(P<0.001).Univariate analysis showed that the NLN count,age,tumor site,tumor size and T classification were significant prognostic factors for the OS of jejunoileal NETs,while the number of positive lymph nodes had no significant impact on OS(P=0.513).Multivariate analysis indicated that the NLN count was an independent prognostic factor for OS of jejunoileal NETs.A higher NLN count was associated with better OS(hazards ratio:0.641;95%confidence interval:0.519-0.793;P<0.001).Compared with 2 other prognostic systems,the NLN counts in this study had similar prognostic value in patients with jejunoileal NETs.Our findings suggest that the NLN count is an important independent prognostic factor for patients with jejunoileal NETs,and that it is a good adjunct for disease staging.

Clinicopathological parameters predicting recurrence of pT1N0 esophageal squamous cell carcinoma

AIM To identify the clinicopathological characteristics of pT1 N0 esophageal squamous cell carcinoma(ESCC) that are associated with tumor recurrence. METHODS We reviewed 216 pT1 N0 thoracic ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy without preoperative chemoradiotherapy. After excluding those cases with clinical follow-up recorded fewer than 3 mo and those who died within 3 mo of surgery, we included 199 cases in the current analysis. Overall survival and recurrencefree survival were assessed by the Kaplan-Meier method, and clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence(≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.RESULTS Forty-seven(24%) patients had a recurrence at 3 to 178(median, 33) mo. The 5-year recurrence-free survival rate was 80.7%. None of 13 asymptomatic cases had a recurrence. Preoperative clinical symptoms, upper thoracic location, ulcerative or intraluminal mass macroscopic tumor type, tumor invasion depth level, basaloid histology, angiolymphatic invasion, tumor thickness, submucosal invasion thickness, diameter of the largest single tongue of invasion, and complete negative aberrant p53 expression were significantly related to tumor recurrence and/or recurrence-free survival. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence(Hazard ratios = 3.26, 3.42, and 2.06, P < 0.001, P < 0.001, and P = 0.002, respectively), and a nomogram for predicting recurrence-free survival with these three predictors was constructed. Upper thoracic tumor location and angiolymphatic invasion were independent predictors of distant recurrence. Upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and diameter of the largest single tongue of invasion were independent predictors of early recurrence.CONCLUSION These results should be useful for designing optimal individual follow-up and therapy for patients with T1 N0 ESCC.

血管内皮生长因子-C和sonic hedgehog在食管鳞状细胞癌中的表达

目的 探讨血管内皮生长因子-C(VEGF-C)和sonic hedgehog(SHH)在食管鳞状细胞癌(ESCC)组织中的表达及其与淋巴结转移的关系.方法 应用免疫组织化学法检测40例ESCC组织和30例癌旁正常黏膜组织中VEGF-C及SHH的表达.结果 40例ESCC组织中25例(62.5%)出现VEGF-C阳性,24例(60.0%)出现SHH阳性;癌旁正常食管黏膜组织30例中仅5例(16.7%)出现VEGF-C阳性,8例(26.7%)出现SHH阳性,其差异均有统计学意义(P＜0.05).在VEGF-C阳性的25例ESCC组织中19例出现淋巴结转移,而在VEGF-C阴性的15例ESCC组织中仅2例出现淋巴结转移,其差异有统计学意义(P＜0.05);SHH表达阳性的24例ESCC中18例有淋巴结转移,而SHH表达阴性的16例ESCC中7例有淋巴结转移,其差异有统计学意义(P＜0.05).结论 VEGF-C和SHH参与了ECSS的发生发展,且与其淋巴结转移的发生有关.对于VEGF-C及SHH表达阳性的ESCC患者,术前和术中应分别加强对淋巴结转移的评估及清扫,以提高其生存率.