Risk factors for lymph node metastasis in superficial esophageal squamous cell carcinoma

In this editorial,we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology in 2023.We focused on identifying risk factors for lymph node metastasis(LNM)in superficial esophageal squamous cell carcinoma(SESCC)patients and how to construct a simple and reliable clinical prediction model to assess the risk of LNM in SESCC patients,thereby helping to guide the selection of an appropriate treatment plan.The current standard treatment for SESCC is radical esophagectomy with lymph node dissection.However,esophagectomy is associated with considerable morbidity and mortality.Endoscopic resection(ER)offers a safer and less invasive alternative to surgical resection and can enable the patient's quality of life to be maintained while providing a satisfactory outcome.However,since ER is a localized treatment that does not allow for lymph node dissection,the risk of LNM in SESCC limits the effectiveness of ER.Understanding LNM status can aid in determining whether patients with SESCC can be cured by ER without the need for additional esophagectomy.Previous studies have shown that tumor size,macroscopic type of tumor,degree of differentiation,depth of tumor invasion,and lymphovascular invasion are factors associated with LNM in patients with SESCC.In addition,tumor budding is commonly associated with LNM,recurrence,and distant metastasis,but this topic has been less covered in previous studies.By comprehensively evaluating the above risk factors for LNM,useful evidence can be obtained for doctors to select appropriate treatments for SESCC patients.

Magnetic resonance imaging-based lymph node radiomics for predicting the metastasis of evaluable lymph nodes in rectal cancer

BACKGROUND Lymph node(LN)staging in rectal cancer(RC)affects treatment decisions and patient prognosis.For radiologists,the traditional preoperative assessment of LN metastasis(LNM)using magnetic resonance imaging(MRI)poses a challenge.AIM To explore the value of a nomogram model that combines Conventional MRI and radiomics features from the LNs of RC in assessing the preoperative metastasis of evaluable LNs.METHODS In this retrospective study,270 LNs(158 nonmetastatic,112 metastatic)were randomly split into training(n=189)and validation sets(n=81).LNs were classified based on pathology-MRI matching.Conventional MRI features[size,shape,margin,T2-weighted imaging(T2WI)appearance,and CE-T1-weighted imaging(T1WI)enhancement]were evaluated.Three radiomics models used 3D features from T1WI and T2WI images.Additionally,a nomogram model combining conventional MRI and radiomics features was developed.The model used univariate analysis and multivariable logistic regression.Evaluation employed the receiver operating characteristic curve,with DeLong test for comparing diagnostic performance.Nomogram performance was assessed using calibration and decision curve analysis.RESULTS The nomogram model outperformed conventional MRI and single radiomics models in evaluating LNM.In the training set,the nomogram model achieved an area under the curve(AUC)of 0.92,which was significantly higher than the AUCs of 0.82(P<0.001)and 0.89(P<0.001)of the conventional MRI and radiomics models,respectively.In the validation set,the nomogram model achieved an AUC of 0.91,significantly surpassing 0.80(P<0.001)and 0.86(P<0.001),respectively.CONCLUSION The nomogram model showed the best performance in predicting metastasis of evaluable LNs.

Predicting lymph node metastasis in colorectal cancer:An analysis of influencing factors to develop a risk model

BACKGROUND Colorectal cancer(CRC)is a significant global health issue,and lymph node metastasis(LNM)is a crucial prognostic factor.Accurate prediction of LNM is essential for developing individualized treatment strategies for patients with CRC.However,the prediction of LNM is challenging and depends on various factors such as tumor histology,clinicopathological features,and molecular characteristics.The most reliable method to detect LNM is the histopathological examination of surgically resected specimens;however,this method is invasive,time-consuming,and subject to sampling errors and interobserver variability.AIM To analyze influencing factors and develop and validate a risk prediction model for LNM in CRC based on a large patient queue.METHODS This study retrospectively analyzed 300 patients who underwent CRC surgery at two Peking University Shenzhen hospitals between January and December 2021.A deep learning approach was used to extract features potentially associated with LNM from primary tumor histological images while a logistic regression model was employed to predict LNM in CRC using machine-learning-derived features and clinicopathological variables as predictors.RESULTS The prediction model constructed for LNM in CRC was based on a logistic regression framework that incorporated machine learning-extracted features and clinicopathological variables.The model achieved high accuracy(0.86),sensitivity(0.81),specificity(0.87),positive predictive value(0.66),negative predictive value(0.94),area under the curve for the receiver operating characteristic(0.91),and a low Brier score(0.10).The model showed good agreement between the observed and predicted probabilities of LNM across a range of risk thresholds,indicating good calibration and clinical utility.CONCLUSION The present study successfully developed and validated a potent and effective risk-prediction model for LNM in patients with CRC.This model utilizes machine-learning-derived features extracted from primary tumor histology and clinicopathological variables,demonstrating superior performance and clinical applicability compared to existing models.The study provides new insights into the potential of deep learning to extract valuable information from tumor histology,in turn,improving the prediction of LNM in CRC and facilitate risk stratification and decision-making in clinical practice.

Nomogram established using risk factors of early gastric cancer for predicting the lymph node metastasis

BACKGROUND For the prognosis of patients with early gastric cancer(EGC),lymph node metastasis(LNM)plays a crucial role.A thorough and precise evaluation of the patient for LNM is now required.AIM To determine the factors influencing LNM and to construct a prediction model of LNM for EGC patients.METHODS Clinical information and pathology data of 2217 EGC patients downloaded from the Surveillance,Epidemiology,and End Results database were collected and analyzed.Based on a 7:3 ratio,1550 people were categorized into training sets and 667 people were assigned to testing sets,randomly.Based on the factors influencing LNM determined by the training sets,the nomogram was drawn and verified.RESULTS Based on multivariate analysis,age at diagnosis,histology type,grade,T-stage,and size were risk factors of LNM for EGC.Besides,nomogram was drawn to predict the risk of LNM for EGC patients.Among the categorical variables,the effect of grade(well,moderate,and poor)was the most significant prognosis factor.For training sets and testing sets,respectively,area under the receiver-operating characteristic curve of nomograms were 0.751[95%confidence interval(CI):0.721-0.782]and 0.786(95%CI:0.742-0.830).In addition,the calibration curves showed that the prediction model of LNM had good consistency.CONCLUSION Age at diagnosis,histology type,grade,T-stage,and tumor size were independent variables for LNM in EGC.Based on the above risk factors,prediction model may offer some guiding implications for the choice of subsequent therapeutic approaches for EGC.

Risk factors and a predictive nomogram for lymph node metastasis in superficial esophageal squamous cell carcinoma

BACKGROUND Superficial esophageal squamous cell carcinoma(ESCC)is defined as cancer infiltrating the mucosa and submucosa,regardless of regional lymph node metastasis(LNM).Endoscopic resection of superficial ESCC is suitable for lesions that have no or low risk of LNM.Patients with a high risk of LNM always need further treatment after endoscopic resection.Therefore,accurately assessing the risk of LNM is critical for additional treatment options.AIM To analyze risk factors for LNM and develop a nomogram to predict LNM risk in superficial ESCC patients.METHODS Clinical and pathological data of superficial ESCC patients undergoing esophagectomy from January 1,2009 to January 31,2016 were collected.Logistic regression analysis was used to predict LNM risk factors,and a nomogram was developed based on risk factors derived from multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve was used to obtain the accuracy of the nomogram model.RESULTSA total of 4660 patients with esophageal cancer underwent esophagectomy.Of these,474 superficial ESCC patientswere enrolled in the final analysis,with 322 patients in the training set and 142 patients in the validation set.Theprevalence of LNM was 3.29%(5/152)for intramucosal cancer and increased to 26.40%(85/322)for submucosalcancer.Multivariate logistic analysis showed that tumor size,invasive depth,tumor differentiation,infiltrativegrowth pattern,tumor budding,and lymphovascular invasion were significantly correlated with LNM.Anomogram using these six variables showed good discrimination with an area under the ROC curve of 0.789(95%CI:0.737-0.841)in the training set and 0.827(95%CI:0.755-0.899)in the validation set.CONCLUSIONWe developed a useful nomogram model to predict LNM risk for superficial ESCC patients which will facilitateadditional decision-making in treating patients who undergo endoscopic resection.

Prediction of risk factors for lymph node metastasis in early gastric cancer

AIM:To explore risk factors for lymph node metastases in early gastric cancer(EGC) and to confirm the appropriate range of lymph node dissection.METHODS:A total of 202 patients with EGC who underwent curative gastrectomy with lymphadenectomy in the Department of Surgery,Xinhua Hospital and Ruijin Hospital of Shanghai Jiaotong University Medical School between November 2003 and July 2009,were retrospectively reviewed.Both the surgical procedure and the extent of lymph node dissection were based on the recommendations of the Japanese gastric cancer treatment guidelines.The macroscopic type was classified as elevated(type Ⅰ or Ⅱa),flat(Ⅱb),or depressed(Ⅱc or Ⅲ).Histopathologically,papillary and tubular adenocarcinomas were grouped together as differentiated adenocarcinomas,and poorly differentiated and signet-ring cell adenocarcinomas were regarded as undifferentiated adenocarcinomas.Univariate and multivariate analyses of lymph node metastases and patient and tumor characteristics were undertaken.RESULTS:The lymph node metastases rate in patients with EGC was 14.4%.Among these,the rate for mucosal cancer was 5.4%,and 8.9% for submucosal cancer.Univariate analysis showed an obvious correlation between lymph node metastases and tumor location,depth of invasion,morphological classification and venous invasion(χ 2 = 122.901,P = 0.001;χ 2 = 7.14,P = 0.008;χ 2 = 79.523,P = 0.001;χ 2 = 8.687,P = 0.003,respectively).In patients with submucosal cancers,the lymph node metastases rate in patients with venous invasion(60%,3/5) was higher than in those without invasion(20%,15/75)(χ 2 = 4.301,P = 0.038).Multivariate logistic regression analysis revealed that the depth of invasion was the only independent risk factor for lymph node metastases in EGC [P = 0.018,Exp(B) = 2.744].Among the patients with lymph node metastases,29 cases(14.4%) were at N1,seven cases were at N2(3.5%),and two cases were at N3(1.0%).Univariate analysis of variance revealed a close relationship between the depth of invasion and lymph node metastases at pN 1(P = 0.008).CONCLUSION:The depth of invasion was the only independent risk factor for lymph node metastases.Risk factors for metastases should be considered when choosing surgery for EGC.

Risk factors of lymph node metastasis in rectal neuroendocrine tumors

Objective The aim of this study was to investigate the risk factors of lymph node metastasis in rectal neuroendocrine neoplasms(RNENs).Methods We enrolled 168 patients with RNENs as the research object,and their clinicopathological and survival data were collected.The risk factors affecting lymph node metastasis were analyzed retrospectively,and independent risk factors affecting prognosis were evaluated.Results Analysis showed that age,tumor diameter,tumor function,grade,and T stage were correlated with lymph node metastasis(P<0.05).Multiple logistic regression analysis showed that tumor size,grade,and T stage were independent risk factors for lymph node metastasis in patients with RNENs.Kaplan-Meier analysis showed that the 5-year overall survival(OS)of patients with lymph node metastasis was 40.0%(10/25),and that of patients without lymph node metastasis was 93.0%(133/143).The prognosis of RNENs patients with lymph node metastasis along with patients with large tumor diameter and high grade was poor.Cox multivariate analysis showed that tumor diameter(HR=1.985,P=0.008),grade(HR=3.416,P=0.004),T stage(HR=2.413,P=0.014),and lymph node metastasis(HR=3.119,P=0.000)were independent risk factors affecting the prognosis of patients with RNENs.Conclusion Tumor size,grade,and T stage are the main risk factors for lymph node metastasis and prognosis in patients with RNENs.These risk factors should be fully evaluated before surgery.

Study on the risk factors of lymphatic metastasis and the indications of less invasive operations in early gastric cancer

INTRODUCTIONThe principle of surgical treatment for gastric cancer is theradical resectioning although the suitable resetting range fordifferent cases of gastric cancer is still being arguedupon.However,the diagnostic accuracy of

Significance and prognostic value of increased serum direct bilirubin level for lymph node metastasis in Chinese rectal cancer patients

AIM: To determine the significance of increased serum direct bilirubin level for lymph node metastasis(LNM) in Chinese rectal cancer patients, after those with known hepatobiliary and pancreatic diseases were excluded.METHODS: A cohort of 469 patients, who were treated at the China-Japan Friendship Hospital, Ministry of Health(Beijing, China), in the period from January 2003 to June 2011, and with a pathological diagnosis of rectal adenocarcinoma, were recruited. They included 231 patients with LNM(49.3%) and 238 patients without LNM. Follow-up for these patients was taken through to December 31, 2012.RESULTS: The baseline serum direct bilirubin concentration was(median/inter-quartile range) 2.30/1.60-3.42 μmol/L. Univariate analysis showed that compared with patients without LNM, the patients with LNM had an increased level of direct bilirubin(2.50/1.70-3.42 vs 2.10/1.40-3.42, P = 0.025). Multivariate analysis showed that direct bilirubin wasindependently associated with LNM(OR = 1.602; 95%CI: 1.098-2.338, P = 0.015). Moreover, we found that:(1) serum direct bilirubin differs between male and female patients; a higher concentration was associated with poor tumor classification;(2) as the baseline serum direct bilirubin concentration increased, the percentage of patients with LNM increased; and(3) serum direct bilirubin was associated with the prognosis of rectal cancer patients and higher values indicated poor prognosis.CONCLUSION: Higher serum direct bilirubin concentration was associated with the increased risk of LNM and poor prognosis in our rectal cancers.

Risk factors for lymph node metastasis in T1 esophageal squamous cell carcinoma:A systematic review and meta-analysis

BACKGROUND Lymph node metastasis(LNM)affects the application and outcomes of endoscopic resection in T1 esophageal squamous cell carcinoma(ESCC).However,reports of the risk factors for LNM have been controversial.AIM To evaluate risk factors for LNM in T1 ESCC.METHODS We searched Embase,PubMed and Cochrane Library to select studies related to LNM in patients with T1 ESCC.Included studies were divided into LNM and non-LNM groups.We performed a meta-analysis to examine the relationship between LNM and clinicopathologic features.Odds ratio(OR),mean differences and 95%confidence interval(CI)were assessed using a fixed-effects or randomeffects model.RESULTS Seventeen studies involving a total of 3775 patients with T1 ESCC met the inclusion criteria.After excluding studies with heterogeneity based on influence analysis,tumor size(OR=1.93,95%CI=1.49-2.50,P<0.001),tumor location(OR=1.46,95%CI=1.17-1.82,P<0.001),macroscopic type(OR=3.17,95%CI=2.33-4.31,P<0.001),T1 substage(OR=6.28,95%CI=4.93-8.00,P<0.001),differentiation(OR=2.11,95%CI=1.64-2.72,P<0.001)and lymphovascular invasion(OR=5.86,95%CI=4.60-7.48,P<0.001)were found to be significantly associated with LNM.Conversely,sex,age and infiltrative growth pattern were not identified as risk factors for LNM.CONCLUSION A tumor size>2 cm,lower location,nonflat macroscopic type,T1b stage,poor differentiation and lymphovascular invasion were associated with LNM in patients with T1 ESCC.

Radiomics for differentiating tumor deposits from lymph node metastasis in rectal cancer

BACKGROUND Tumor deposits(TDs)are not equivalent to lymph node(LN)metastasis(LNM)but have become independent adverse prognostic factors in patients with rectal cancer(RC).Although preoperatively differentiating TDs and LNMs is helpful in designing individualized treatment strategies and achieving improved prognoses,it is a challenging task.AIM To establish a computed tomography(CT)-based radiomics model for preoperatively differentiating TDs from LNM in patients with RC.METHODS This study retrospectively enrolled 219 patients with RC[TDs+LNM-(n=89);LNM+TDs-(n=115);TDs+LNM+(n=15)]from a single center between September 2016 and September 2021.Single-positive patients(i.e.,TDs+LNM-and LNM+TDs-)were classified into the training(n=163)and validation(n=41)sets.We extracted numerous features from the enhanced CT(region 1:The main tumor;region 2:The largest peritumoral nodule).After deleting redundant features,three feature selection methods and three machine learning methods were used to select the best-performing classifier as the radiomics model(Rad-score).After validating Rad-score,its performance was further evaluated in the field of diagnosing double-positive patients(i.e.,TDs+LNM+)by outlining all peritumoral nodules with diameter(short-axis)>3 mm.RESULTS Rad-score 1(radiomics signature of the main tumor)had an area under the curve(AUC)of 0.768 on the training dataset and 0.700 on the validation dataset.Rad-score 2(radiomics signature of the largest peritumoral nodule)had a higher AUC(training set:0.940;validation set:0.918)than Radscore 1.Clinical factors,including age,gender,location of RC,tumor markers,and radiological features of the largest peritumoral nodule,were excluded by logistic regression.Thus,the combined model was comprised of Rad-scores of 1 and 2.Considering that the combined model had similar AUCs with Rad-score 2(P=0.134 in the training set and 0.594 in the validation set),Rad-score 2 was used as the final model.For the diagnosis of double-positive patients in the mixed group[TDs+LNM+(n=15);single-positive(n=15)],Rad-score 2 demonstrated moderate performance(sensitivity,73.3%;specificity,66.6%;and accuracy,70.0%).CONCLUSION Radiomics analysis based on the largest peritumoral nodule can be helpful in preoperatively differentiating between TDs and LNM.

Correlation between mitochondrial TRAP-1 expression and lymph node metastasis in colorectal cancer

AIM:To evaluate the effect of mitochondrial tumor necrosis factor receptor-associated protein-1(TRAP-1) on the lymph node metastasis(LNM) in Chinese colorectal cancer(CRC) patients,and develop potential LNMassociated biomarkers for CRC using quantitative realtime polymerase chain reaction(RT-PCR) analysis.METHODS:Differences in mitochondrial TRAP-1 gene expression between primary CRC with LNM(LNM CRC) and without LNM(non-LNM CRC) were assessed in 96 Chinese colorectal carcinoma samples using quantitative RT-PCR analysis,Western blotting,and confirmed with immunohistochemical assay.The relationship between clinicopathological parameters and potential diagnostic biomarkers was also examined.RESULTS:TRAP-1 was significantly upregulated in LNM CRC compared with non-LNM CRC,which was confirmed by RT-PCR,Western blotting and immunohistochemical assay.The expression of TRAP-1 in two different metastatic potential human colorectal cancer cell lines,LoVo and HT29,was analyzed with Western blotting.The expression level of TRAP-1 was dramatically higher in LoVo than in HT29.Overexpression of TRAP-1 was significantly associated with LNM(90.2% in LNM group vs 22% in non-LNM group,P < 0.001),the advanced tumor node metastasis stage(89.1% in LNM group vs 26.9% in non-LNM group,P < 0.001),the increased 5-year recurrence rate(82.7% in LNM group vs 22.6% in non-LNM group,P < 0.001) and the decreased 5-year overall survival rate(48.4% in LNM vs 83.2% in non-LNM group,P < 0.001).Univariate and multivariate analyses indicated that TRAP-1 expression was an independent prognostic factor for recurrence and survival of CRC patients(Hazard ratio of 2.445 in recurrence,P = 0.017;2.867 in survival,P = 0.028).CONCLUSION:Mitochondria TRAP-1 affects the lymph node metastasis in CRC,and may be a potential biomarker for LNM and a prognostic factor in CRC.Overexpression of TRAP-1 is a predictive factor for the poor outcome of colorectal cancer patients.

Risk factors for lymph node metastasis in patients with pancreatic neuroendocrine neoplasms

BACKGROUND Although PNENs generally have a better prognosis than pancreatic cancers,some PNENs display malignant behavior including lymph node(LN)metastasis.Complete tumor resection can be the only potentially curative treatment for patients with resectable PNENs.However,the indications for LN dissection are still controversial.Over the last decade,minimally invasive surgery such as laparoscopic pancreatic surgery(LPS)has been increasingly performed for pancreatic tumors including PNENs.AIM To investigate the risk factors for LN metastasis in PNENs and to select appropriate patients for limited surgery by LPS.METHODS From April 2001 to December 2019,92 patients underwent pancreatic resection for PNENs at Kumamoto University Hospital.Finally,82 patients were enrolled in this study.Using perioperative factors,we examined the predictive factors for LN metastasis in PNENs.RESULTS Among the 82 patients,the percentage of LN metastasis according to the pathological findings was 12%(10/82 cases).The median tumor size was 12 mm(range:5-90 mm).The median tumor size in the LN-positive group(37 mm)was significantly larger than that in the LN-negative group(12 mm)(P=0.0001).Multivariate analyses revealed that larger tumor size(≥20 mm)was an independent risk factor for LN metastasis(odds ratio 16.8,P=0.0062).In patients with small tumors(≤10 mm),LN metastasis was not found.CONCLUSION Larger tumor size(≥20 mm)is an independent risk factor for LN metastasis in PNENs.In smaller PNENs(≤10 mm),we may be able to choose limited surgery without LN dissection.

Impact of metastatic lymph node ratio in node-positive colorectal cancer

Colorectal cancer(CRC) is one of the most common malignant diseases in the world.Presently,the most widely used staging system for CRC is the tumor nodes metastasis classification system,which classifies patients into prognostic groups according to the depth of the primary tumor,presence of regional lymph node(LN) metastases,and evidence of distant metastatic spread.The number of LNs with confirmed metastasis is related to the severity of the disease,but this number depends on the number of LNs retrieved,which varies depending on patient age,tumor grade,surgical extent,and tumor site.Numerous studies and a recent structured review have demonstrated associated improvements in the survival of CRC patients with increasing numbers of LNs retrieved for examination.Hence,the impact of lymph node ratio(LNR),defined as the number of metastatic LNs divided by the number of LNs retrieved,has been investigated in various malignancies,including CRC.In this editorial,we review the literature demonstrating the clinicopathological significance of LNR in CRC pati-ents.Some reports have indicated the advantage of considering the LNR compared to the number of LNs retrieved and/or LN status.When the LNR is taken into consideration for survival analysis,the number of LNs retrieved and/or the LN status is not always found to be a prognostic factor.The cut-off points for LNRs were proposed in numerous studies.However,optimal thresholds for LNRs have not yet received consensus.It is still unclear whether the LNR has more prognostic validity than N stage.For all these reasons,the potential advantages of LNRs in the staging system should be investigated in large prospective data sets.

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.

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.

Interleukin-24 is correlated with differentiation and lymph node numbers in rectal cancer

AIM:To assess the significance of interleukin(IL)-24 and vascular endothelial growth factor(VEGF)expression in lymph-node-positive rectal cancer. METHODS:Between 1998 and 2005,90 rectal adenocarcinoma patients with lymph node involvement were enrolled.All patients received radical surgery and postoperative pelvic chemoradiotherapy of 50.4-54.0 Gy.Chemotherapy of 5-fluorouracil and leucovorin or levamisole was given intravenously during the first and last week of radiotherapy,and then monthly for about 6 mo.Expression of IL-24 and VEGF was evaluated by immunohistochemical staining of surgical specimens, and their relations with patient characteristics and survival were analyzed.The median follow-up of surviving patients was 73 mo(range:52-122 mo). RESULTS:IL-24 expression was found in 81 out of 90 patients;31 showed weak intensity and 50 showedstrong intensity.VEGF expression was found in 64 out of 90 patients.Negative and weak intensities of IL-24 expression were classified as negative expression for analysis.IL-24 expression was significantly reduced in poorly differentiated tumors in comparison with well or moderately differentiated tumors(P=0.004),N2b to earlier N stages(P=0.016),and stageⅢc to stageⅢ a orⅢb(P=0.028).The number of involved lymph nodes was also significantly reduced in IL-24-positive patients in comparison with IL-24-negative ones. There was no correlation between VEGF expression and patient characteristics.Expression of IL-24 and VEGF was not correlated with survival,but N stage and stages were significantly correlated with survival. CONCLUSION:IL-24 expression was significantly correlated with histological differentiation,and inversely correlated with the degree of lymph node involvement in stageⅢrectal cancer.

T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis:A case report

BACKGROUND There are a few cases of lateral lymph node(LLN)metastasis(LLNM)of T1 rectal cancer.Moreover,LLNM is easily missed,especially in patients with early-stage rectal cancer.To our knowledge,the possibility of bilateral LLNM before surgery has not been reported in previous studies.CASE SUMMARY A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp.The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma.She was considered to have bilateral LLNM after the examination at our hospital.Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM.The patient received longcourse adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.CONCLUSION T1 rectal cancer could lead to LLNM and possibly,bilateral LLNM.Therefore,adequate clinical evaluation is essential for these patients.

Lateral pelvic lymph nodes for rectal cancer:A review of diagnosis and management

The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node(LPLN)metastasis of rectal cancer are described in this review.Magnetic resonance imaging(MRI)is recommended for the diagnosis of LPLN metastasis.A LPLN-positive status on MRI is a strong risk factor for metastasis,and evaluation by MRI is important for deciding treatment strategy.LPLN dissection(LPLD)has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications;therefore,LPLD may not be appropriate for cases that are less likely to have LPLN metastasis.Radiation therapy(RT)and chemoradiation therapy(CRT)have limited effects in cases with suspected LPLN metastasis,but a combination of preoperative CRT and LPLD may improve the treatment outcome.Thus,RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.

A clinical analysis of risk factor with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy

Objective To investigate the risk factors with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy. Methods The subjects were 82 patients with pN0 esophagea cancer who underwent Ivor-Lewis esophagectomy from January 2001 to January 2005. By using RT-PCR,VEGF C mRNA was detected in tumor issues,and Mucin (MUC1) mRNA was detected in lymph nodes. The Kaplan-Meier method was used to calculate the survival