Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the acc...Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the accuracy of sonography in the diagnosis of loco-regional lymphatic recurrences in comparison to the core needle biopsy results. Materials and Methods: Among 6455 patients who were followed up with clinical examination, mammography and ultrasound between January 2004 and November 2011, 125 (1.93%) patients had to be investigated with a core needle biopsy of a sonographically suspicious loco-regional lymph node. Results: Among the whole series, a total of 142 ultrasound-guided core needle biopsies were performed. Follow-up for the primary tumor lasted for a median time of 6.1 years (range 1 - 27 years). Ultrasound of suspicious loco-regional lymph nodes showed a sensitivity of 89.5%, a specificity of 87.1% and a positive predictive value of 89.5%. Conclusions: In our experience, ultrasound of suspicious loco-regional lymph nodes showed good accuracy and it should be a part of the standard examinations performed during follow-up for breast cancer.展开更多
目的 分析甲状腺乳头状癌(PTC)超声图像表现在预测颈部Ⅵ区淋巴结转移(lymph node metastasis in the cervicalregion Ⅵ,CLNM-Ⅵ)危险度的临床价值。方法 选取2022年4月~2023年6月在河北省沧州中西医结合医院接受手术治疗并经病理证实...目的 分析甲状腺乳头状癌(PTC)超声图像表现在预测颈部Ⅵ区淋巴结转移(lymph node metastasis in the cervicalregion Ⅵ,CLNM-Ⅵ)危险度的临床价值。方法 选取2022年4月~2023年6月在河北省沧州中西医结合医院接受手术治疗并经病理证实的350例PTC患者,根据术后病理结果,将患者分为CLNM-Ⅵ组和非CLNM-Ⅵ组。收集并对比两组术前超声图像表现及临床病理特征,应用Logistic回归分析PTC患者CLNM-Ⅵ危险因素,受试者工作特征(ROC)曲线分析PTC超声图像表现对CLNM-Ⅵ的预测价值。结果 单因素分析显示,CLNM-Ⅵ组男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、点状强回声的构成比均大于非CLNM-Ⅵ组(P均<0.05)。Logistic回归分析显示,男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、病灶内可见点状强回声是CLNM-Ⅵ的独立危险因素(P均<0.05);进一步经ROC曲线分析显示,以上预测CLNM-Ⅵ的AUC分别为0.565、0.580、0.529、0.585、0.582、0.582,联合预测AUC为0.708。结论PTC超声图像表现在CLNM-Ⅵ风险评估中具有重要意义,可为PTC的预后判断提供一定的参考依据。展开更多
BACKGROUND Increasing evidence have shown that regional lymph node metastasis is a critical prognostic factor in gastric cancer(GC).In addition,lymph node dissection is a key factor in determining the appropriate trea...BACKGROUND Increasing evidence have shown that regional lymph node metastasis is a critical prognostic factor in gastric cancer(GC).In addition,lymph node dissection is a key factor in determining the appropriate treatment for GC.However,the association between the number of positive lymph nodes and area of lymph node metastasis in GC remains unclear.AIM To investigate the clinical value of regional lymph node sorting after radical gastrectomy for GC.METHODS This study included 661 patients with GC who underwent radical gastrectomy at Tianjin Medical University General Hospital between January 2012 and June 2020.The patients were divided into regional sorting and non-sorting groups.Clinicopathological data were collected and retrospectively reviewed to determine the differences in the total number of lymph nodes and number of positive lymph nodes between the groups.Independent sample t-tests were used for intergroup comparisons.Continuous variables that did not conform to a normal distribution were expressed as median(interquartile range),and the Mann-Whitney U test was used for inter-group comparisons.RESULTS There were no significant differences between the groups in terms of the surgical method,tumor site,immersion depth,and degree of differentiation.The total number of lymph nodes was significantly higher in the regional sorting group(n=324)than in the non-sorting group(n=337)(32.5 vs 21.2,P<0.001).There was no significant difference in the number of positive lymph nodes between the two groups.A total of 212 patients with GC had lymph node metastasis in the lymph node regional sorting group,including 89(41.98%)cases in the first dissection station and 123(58.02%)cases in the second dissection station.Binary and multivariate logistic regression results showed that the number of positive lymph nodes(P<0.001)was an independent risk factor for lymph node metastases at the second dissection station.CONCLUSION Regional sorting of lymph nodes after radical gastrectomy may increase the number of detected lymph nodes,thereby improving the reliability and accuracy of lymph node staging in clinical practice.展开更多
Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on t...Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on the metastatic spread of oral cancer,particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes.These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer.Combined information on surgical anatomy,clinical observations,means of detection,and prognostic value is presented.Anatomically obtained incidence of lingual nodes ranges from 8.6%to 30.2%.Incidence of lingual lymph node metastasis ranges from 1.3%to 17.1%.It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control.Extended resection volume,which is required for the surgical treatment of lingual node metastasis,cannot be implied to every tongue cancer patient.As these lesions significantly influence prognosis,special efforts of their detection must be made.Reasonably,every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis.Lymphographic tracing methods,which are currently implied for sentinel lymph node biopsies,may improve the detection of lingual lymph nodes.展开更多
The amount of lymph node dissection(LD) required during surgical treatment of gastric cancer surgery has been quite controversial.In the 1970 s and 1980 s,Japanese surgeons developed a doctrine of aggressive preventiv...The amount of lymph node dissection(LD) required during surgical treatment of gastric cancer surgery has been quite controversial.In the 1970 s and 1980 s,Japanese surgeons developed a doctrine of aggressive preventive gastric cancer surgery that was based on extended(D2) LD volumes.The West has relatively lower incidence rates of gastric cancer,and in Europe and the United States the most common LD volume was D0-1.This eventually caused a scientific conflict between the Eastern and Western schools of surgical thought.:Japanese surgeons determinedly used D2 LD in surgical practice,whereas European surgeons insisted on repetitive clinical trials in the European patient population.Today,however,one can observe the results of this complex evolution of views.The D2 LD is regarded as an unambiguous standard of gastric cancer surgical treatment in specialized European centers.Such a consensus of the Eastern and Western surgical schools became possible due to the longstanding scientific and practical search for methods that would help improve the results of gastric cancer surgeries using evidence-based medicine.Today,we can claim that D2 LD could improve the prognosis in European populations of patients with gastric cancer,but only when the surgical quality of LD execution is adequate.展开更多
目的:比较和分析两种基于CT影像的胃癌区域淋巴结体积测量方法--球面感兴趣区(Sphere ROI) CT阈值法和手动勾画计算容积法的一致性。方法:收集接受根治性手术治疗的81例胃癌患者资料,根据纳入和排除标准,从转移性、非转移性淋巴结中各选...目的:比较和分析两种基于CT影像的胃癌区域淋巴结体积测量方法--球面感兴趣区(Sphere ROI) CT阈值法和手动勾画计算容积法的一致性。方法:收集接受根治性手术治疗的81例胃癌患者资料,根据纳入和排除标准,从转移性、非转移性淋巴结中各选取50枚进行测量和分析,比较两种方法测量淋巴结体积的一致性。一致性检验采用Kappa检验和组内相关系数(ICC)检验。结果:2名医师应用手动勾画计算容积法测量淋巴结体积的一致性(Kappa=0.823,ICC=0.980),以及应用Sphere ROI CT阈值法测量淋巴结体积的一致性(Kappa=0.892,ICC=0.992)均良好,且后者优于前者。另一方面,医师A在不同时间点应用手动勾画计算容积法测量淋巴结体积的一致性(Kappa=0.822, ICC=0.988),以及应用Sphere ROI CT阈值法测量淋巴结体积的一致性(Kappa=0.874,ICC=0.994)也较好,且后者优于前者。结论:Sphere ROI CT阈值法在胃癌区域淋巴结体积测量的一致性优于手动勾画计算容积法,且操作更简单便捷,推荐在胃癌区域淋巴结体积测量上优先考虑使用Sphere ROI CT阈值法。展开更多
目的 分析双源CT能谱成像多参数对宫颈癌区域淋巴结的定性诊断价值。方法 选择2021年5月至2022年5月新疆维吾尔自治区人民医院收治的102例经病理活检诊断为宫颈癌且存在区域淋巴结肿大患者,年龄27~68岁,平均年龄51.23岁;身体质量指数21~...目的 分析双源CT能谱成像多参数对宫颈癌区域淋巴结的定性诊断价值。方法 选择2021年5月至2022年5月新疆维吾尔自治区人民医院收治的102例经病理活检诊断为宫颈癌且存在区域淋巴结肿大患者,年龄27~68岁,平均年龄51.23岁;身体质量指数21~29 kg/m^(2),平均身体质量指数22.86 kg/m^(2);根据国际妇产科联盟(FIGO)分期标准,Ⅰ期15例,Ⅱ期39例,Ⅲ期42例,Ⅳ期6例;组织病理学类型,鳞癌86例,腺癌12例,腺鳞癌3例,透明细胞癌1例。所有患者均进行双源CT能谱成像检查,行动脉期及静脉期增强扫描,检测标准化碘浓度(NIC)和能谱曲线斜率(λHU);根据术后淋巴结的病理结果,分为淋巴结转移组和淋巴结未转移组,比较两组动脉期及静脉期的NIC、λHU,使用受试者工作特性(ROC)曲线分析其诊断效能。结果 在102例经病理活检诊断为宫颈癌且存在区域淋巴结肿大患者中,CT检出淋巴结共531个。根据术后淋巴结的病理诊断,分为淋巴结转移组345个和淋巴结未转移组186个。淋巴结转移组动脉期及静脉期的NIC、λHU均大于淋巴结未转移组,差异均有统计学意义(动脉期:0.41±0.19 vs 0.20±0.12,6.78±1.43 vs 2.41±0.55。静脉期:0.68±0.56 vs 0.39±0.27,5.85±1.37 vs 3.72±0.61。P <0.05);经ROC曲线分析,动脉期NIC、λHU及静脉期NIC、λHU定性诊断宫颈癌区域淋巴结的ROC曲线下面积(AUC)分别为0.925、0.905和0.935、0.930,最佳截断值分别为0.44、7.53和0.76、5.95,灵敏度分别为76.65%、68.91%和72.53%、75.76%,特异度分别为81.92%、93.47%和74.58%、82.43%。结论 运用双源CT能谱成像多参数进行定量分析,在宫颈癌区域淋巴结定性诊断中具有较大意义,可作为术前判断区域淋巴结转移的重要依据之一。展开更多
BACKGROUND Lung cancer(LC)is the leading cause of morbidity and mortality among malignant neoplasms.Improving the diagnosis and treatment of LC remains an urgent task of modern oncology.Previously,we established that ...BACKGROUND Lung cancer(LC)is the leading cause of morbidity and mortality among malignant neoplasms.Improving the diagnosis and treatment of LC remains an urgent task of modern oncology.Previously,we established that in gastric,breast and cervical cancer,tumor microvessels(MVs)differ in morphology and have different prognostic significance.The connection between different types of tumor MVs and the progression of LC is not well understood.AIM To evaluate the morphological features and clinical significance of tumor MVs in lung squamous cell carcinoma(LUSC).METHODS A single-center retrospective cohort study examined medical records and archival paraffin blocks of 62 and 180 patients with stage I-IIIA LUSC in the training and main cohorts,respectively.All patients underwent radical surgery(R0)at the Orenburg Regional Cancer Clinic from May/20/2009 to December/14/2021.Tumor sections were routinely processed,and routine Mayer's hematoxylin and eosin staining and immunohistochemical staining for cluster of differentiation 34(CD34),podoplanin,Snail and hypoxia-inducible factor-1 alpha were performed.The morphological features of different types of tumor MVs,tumor parenchyma and stroma were studied according to clinicopathological characteristics and LUSC prognosis.Statistical analysis was performed using Statistica 10.0 software.Univariate and multivariate logistic regression analyses were performed to identify potential risk factors for LUSC metastasis to regional lymph nodes(RLNs)and disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with and without metastases in RLNs and those with and without disease recurrence.The effectiveness of the predictive models was assessed by the area under the curve.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.A value of P<0.05 was considered to indicate statistical significance.RESULTS Depending on the morphology,we classified tumor vessels into the following types:normal MVs,dilated capillaries(DCs),atypical DCs,DCs with weak expression of CD34,"contact-type"DCs,structures with partial endothelial linings,capillaries in the tumor solid component and lymphatic vessels in lymphoid and polymorphocellular infiltrates.We also evaluated the presence of loose,fine fibrous connective tissue(LFFCT)and retraction clefts in the tumor stroma,tumor spread into the alveolar air spaces(AASs)and fragmentation of the tumor solid component.According to multivariate analysis,the independent predictors of LUSC metastasis in RLNs were central tumor location(P<0.00001),the presence of retraction clefts(P=0.003),capillaries in the tumor solid component(P=0.023)and fragmentation in the tumor solid component(P=0.009),whereas the independent predictors of LUSC recurrence were tumor grade 3(G3)(P=0.001),stage N2(P=0.016),the presence of LFFCT in the tumor stroma(P<0.00001),fragmentation of the tumor solid component(P=0.0001),and the absence of tumor spread through the AASs(P=0.0083).CONCLUSION The results obtained confirm the correctness of our previously proposed classification of different types of tumor vessels and may contribute to improving the diagnosis and treatment of LUSC.展开更多
文摘Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the accuracy of sonography in the diagnosis of loco-regional lymphatic recurrences in comparison to the core needle biopsy results. Materials and Methods: Among 6455 patients who were followed up with clinical examination, mammography and ultrasound between January 2004 and November 2011, 125 (1.93%) patients had to be investigated with a core needle biopsy of a sonographically suspicious loco-regional lymph node. Results: Among the whole series, a total of 142 ultrasound-guided core needle biopsies were performed. Follow-up for the primary tumor lasted for a median time of 6.1 years (range 1 - 27 years). Ultrasound of suspicious loco-regional lymph nodes showed a sensitivity of 89.5%, a specificity of 87.1% and a positive predictive value of 89.5%. Conclusions: In our experience, ultrasound of suspicious loco-regional lymph nodes showed good accuracy and it should be a part of the standard examinations performed during follow-up for breast cancer.
文摘目的 分析甲状腺乳头状癌(PTC)超声图像表现在预测颈部Ⅵ区淋巴结转移(lymph node metastasis in the cervicalregion Ⅵ,CLNM-Ⅵ)危险度的临床价值。方法 选取2022年4月~2023年6月在河北省沧州中西医结合医院接受手术治疗并经病理证实的350例PTC患者,根据术后病理结果,将患者分为CLNM-Ⅵ组和非CLNM-Ⅵ组。收集并对比两组术前超声图像表现及临床病理特征,应用Logistic回归分析PTC患者CLNM-Ⅵ危险因素,受试者工作特征(ROC)曲线分析PTC超声图像表现对CLNM-Ⅵ的预测价值。结果 单因素分析显示,CLNM-Ⅵ组男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、点状强回声的构成比均大于非CLNM-Ⅵ组(P均<0.05)。Logistic回归分析显示,男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、病灶内可见点状强回声是CLNM-Ⅵ的独立危险因素(P均<0.05);进一步经ROC曲线分析显示,以上预测CLNM-Ⅵ的AUC分别为0.565、0.580、0.529、0.585、0.582、0.582,联合预测AUC为0.708。结论PTC超声图像表现在CLNM-Ⅵ风险评估中具有重要意义,可为PTC的预后判断提供一定的参考依据。
基金the Fundamental Scientific Research Project of Tianjin Universities of China,No.2017KJ191.
文摘BACKGROUND Increasing evidence have shown that regional lymph node metastasis is a critical prognostic factor in gastric cancer(GC).In addition,lymph node dissection is a key factor in determining the appropriate treatment for GC.However,the association between the number of positive lymph nodes and area of lymph node metastasis in GC remains unclear.AIM To investigate the clinical value of regional lymph node sorting after radical gastrectomy for GC.METHODS This study included 661 patients with GC who underwent radical gastrectomy at Tianjin Medical University General Hospital between January 2012 and June 2020.The patients were divided into regional sorting and non-sorting groups.Clinicopathological data were collected and retrospectively reviewed to determine the differences in the total number of lymph nodes and number of positive lymph nodes between the groups.Independent sample t-tests were used for intergroup comparisons.Continuous variables that did not conform to a normal distribution were expressed as median(interquartile range),and the Mann-Whitney U test was used for inter-group comparisons.RESULTS There were no significant differences between the groups in terms of the surgical method,tumor site,immersion depth,and degree of differentiation.The total number of lymph nodes was significantly higher in the regional sorting group(n=324)than in the non-sorting group(n=337)(32.5 vs 21.2,P<0.001).There was no significant difference in the number of positive lymph nodes between the two groups.A total of 212 patients with GC had lymph node metastasis in the lymph node regional sorting group,including 89(41.98%)cases in the first dissection station and 123(58.02%)cases in the second dissection station.Binary and multivariate logistic regression results showed that the number of positive lymph nodes(P<0.001)was an independent risk factor for lymph node metastases at the second dissection station.CONCLUSION Regional sorting of lymph nodes after radical gastrectomy may increase the number of detected lymph nodes,thereby improving the reliability and accuracy of lymph node staging in clinical practice.
文摘Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on the metastatic spread of oral cancer,particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes.These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer.Combined information on surgical anatomy,clinical observations,means of detection,and prognostic value is presented.Anatomically obtained incidence of lingual nodes ranges from 8.6%to 30.2%.Incidence of lingual lymph node metastasis ranges from 1.3%to 17.1%.It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control.Extended resection volume,which is required for the surgical treatment of lingual node metastasis,cannot be implied to every tongue cancer patient.As these lesions significantly influence prognosis,special efforts of their detection must be made.Reasonably,every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis.Lymphographic tracing methods,which are currently implied for sentinel lymph node biopsies,may improve the detection of lingual lymph nodes.
文摘The amount of lymph node dissection(LD) required during surgical treatment of gastric cancer surgery has been quite controversial.In the 1970 s and 1980 s,Japanese surgeons developed a doctrine of aggressive preventive gastric cancer surgery that was based on extended(D2) LD volumes.The West has relatively lower incidence rates of gastric cancer,and in Europe and the United States the most common LD volume was D0-1.This eventually caused a scientific conflict between the Eastern and Western schools of surgical thought.:Japanese surgeons determinedly used D2 LD in surgical practice,whereas European surgeons insisted on repetitive clinical trials in the European patient population.Today,however,one can observe the results of this complex evolution of views.The D2 LD is regarded as an unambiguous standard of gastric cancer surgical treatment in specialized European centers.Such a consensus of the Eastern and Western surgical schools became possible due to the longstanding scientific and practical search for methods that would help improve the results of gastric cancer surgeries using evidence-based medicine.Today,we can claim that D2 LD could improve the prognosis in European populations of patients with gastric cancer,but only when the surgical quality of LD execution is adequate.
文摘目的:比较和分析两种基于CT影像的胃癌区域淋巴结体积测量方法--球面感兴趣区(Sphere ROI) CT阈值法和手动勾画计算容积法的一致性。方法:收集接受根治性手术治疗的81例胃癌患者资料,根据纳入和排除标准,从转移性、非转移性淋巴结中各选取50枚进行测量和分析,比较两种方法测量淋巴结体积的一致性。一致性检验采用Kappa检验和组内相关系数(ICC)检验。结果:2名医师应用手动勾画计算容积法测量淋巴结体积的一致性(Kappa=0.823,ICC=0.980),以及应用Sphere ROI CT阈值法测量淋巴结体积的一致性(Kappa=0.892,ICC=0.992)均良好,且后者优于前者。另一方面,医师A在不同时间点应用手动勾画计算容积法测量淋巴结体积的一致性(Kappa=0.822, ICC=0.988),以及应用Sphere ROI CT阈值法测量淋巴结体积的一致性(Kappa=0.874,ICC=0.994)也较好,且后者优于前者。结论:Sphere ROI CT阈值法在胃癌区域淋巴结体积测量的一致性优于手动勾画计算容积法,且操作更简单便捷,推荐在胃癌区域淋巴结体积测量上优先考虑使用Sphere ROI CT阈值法。
文摘目的 分析双源CT能谱成像多参数对宫颈癌区域淋巴结的定性诊断价值。方法 选择2021年5月至2022年5月新疆维吾尔自治区人民医院收治的102例经病理活检诊断为宫颈癌且存在区域淋巴结肿大患者,年龄27~68岁,平均年龄51.23岁;身体质量指数21~29 kg/m^(2),平均身体质量指数22.86 kg/m^(2);根据国际妇产科联盟(FIGO)分期标准,Ⅰ期15例,Ⅱ期39例,Ⅲ期42例,Ⅳ期6例;组织病理学类型,鳞癌86例,腺癌12例,腺鳞癌3例,透明细胞癌1例。所有患者均进行双源CT能谱成像检查,行动脉期及静脉期增强扫描,检测标准化碘浓度(NIC)和能谱曲线斜率(λHU);根据术后淋巴结的病理结果,分为淋巴结转移组和淋巴结未转移组,比较两组动脉期及静脉期的NIC、λHU,使用受试者工作特性(ROC)曲线分析其诊断效能。结果 在102例经病理活检诊断为宫颈癌且存在区域淋巴结肿大患者中,CT检出淋巴结共531个。根据术后淋巴结的病理诊断,分为淋巴结转移组345个和淋巴结未转移组186个。淋巴结转移组动脉期及静脉期的NIC、λHU均大于淋巴结未转移组,差异均有统计学意义(动脉期:0.41±0.19 vs 0.20±0.12,6.78±1.43 vs 2.41±0.55。静脉期:0.68±0.56 vs 0.39±0.27,5.85±1.37 vs 3.72±0.61。P <0.05);经ROC曲线分析,动脉期NIC、λHU及静脉期NIC、λHU定性诊断宫颈癌区域淋巴结的ROC曲线下面积(AUC)分别为0.925、0.905和0.935、0.930,最佳截断值分别为0.44、7.53和0.76、5.95,灵敏度分别为76.65%、68.91%和72.53%、75.76%,特异度分别为81.92%、93.47%和74.58%、82.43%。结论 运用双源CT能谱成像多参数进行定量分析,在宫颈癌区域淋巴结定性诊断中具有较大意义,可作为术前判断区域淋巴结转移的重要依据之一。
文摘BACKGROUND Lung cancer(LC)is the leading cause of morbidity and mortality among malignant neoplasms.Improving the diagnosis and treatment of LC remains an urgent task of modern oncology.Previously,we established that in gastric,breast and cervical cancer,tumor microvessels(MVs)differ in morphology and have different prognostic significance.The connection between different types of tumor MVs and the progression of LC is not well understood.AIM To evaluate the morphological features and clinical significance of tumor MVs in lung squamous cell carcinoma(LUSC).METHODS A single-center retrospective cohort study examined medical records and archival paraffin blocks of 62 and 180 patients with stage I-IIIA LUSC in the training and main cohorts,respectively.All patients underwent radical surgery(R0)at the Orenburg Regional Cancer Clinic from May/20/2009 to December/14/2021.Tumor sections were routinely processed,and routine Mayer's hematoxylin and eosin staining and immunohistochemical staining for cluster of differentiation 34(CD34),podoplanin,Snail and hypoxia-inducible factor-1 alpha were performed.The morphological features of different types of tumor MVs,tumor parenchyma and stroma were studied according to clinicopathological characteristics and LUSC prognosis.Statistical analysis was performed using Statistica 10.0 software.Univariate and multivariate logistic regression analyses were performed to identify potential risk factors for LUSC metastasis to regional lymph nodes(RLNs)and disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with and without metastases in RLNs and those with and without disease recurrence.The effectiveness of the predictive models was assessed by the area under the curve.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.A value of P<0.05 was considered to indicate statistical significance.RESULTS Depending on the morphology,we classified tumor vessels into the following types:normal MVs,dilated capillaries(DCs),atypical DCs,DCs with weak expression of CD34,"contact-type"DCs,structures with partial endothelial linings,capillaries in the tumor solid component and lymphatic vessels in lymphoid and polymorphocellular infiltrates.We also evaluated the presence of loose,fine fibrous connective tissue(LFFCT)and retraction clefts in the tumor stroma,tumor spread into the alveolar air spaces(AASs)and fragmentation of the tumor solid component.According to multivariate analysis,the independent predictors of LUSC metastasis in RLNs were central tumor location(P<0.00001),the presence of retraction clefts(P=0.003),capillaries in the tumor solid component(P=0.023)and fragmentation in the tumor solid component(P=0.009),whereas the independent predictors of LUSC recurrence were tumor grade 3(G3)(P=0.001),stage N2(P=0.016),the presence of LFFCT in the tumor stroma(P<0.00001),fragmentation of the tumor solid component(P=0.0001),and the absence of tumor spread through the AASs(P=0.0083).CONCLUSION The results obtained confirm the correctness of our previously proposed classification of different types of tumor vessels and may contribute to improving the diagnosis and treatment of LUSC.
