Objective To analyze and screen the risk factors of both immunohistochemistry and pathology for lung cancer lymphatic metastasis, and to build a mathematical model for preliminary evaluation. Methods By conducting retrospective studies, the information of lung cancer patients in the General Hospital of Air Force from 2009 to 2011 were collected. Both single and multiple unconditional logistic regression analyses were applied to screen total 27 possible factors for lymphatic metastasis. After the factors with statistical significance were selected, the relevant mathematical model was built and then evaluated by means of receiver operating characteristic (ROC) analysis. Results A total of 216 patients were included. The single analyses on 27 possible factors showed significant differences in the following 10 factors: pathological grade (P=0.00), age (P=0.00), tumor types (P=0.01), nm23 (P=0.00), GSTII (P=0.01), TTF1 (P=0.01), MRP (P=0.01), CK14 (P=0.02), CD56 (P=0.02), and EGFR (P=0.03). The multiple factors unconditional logistic regression analyses on those 10 risk factors screened 4 relevant factors as follows: pathological grade (OR=2.34), age (OR=1.02), nm23 (OR=1.66), and EGFR (OR=1.47). Then a mathematical diagnostic model was established based on those 4 identified risk factors, and the result of ROC analysis showed it could improve the diagnostic sensitivity and specificity compared with the single factor mathematical diagnostic model. Conclusion Pathological grade, age, nm23, and EGFR are related with lung cancer lymphatic metastasis, and all of them are the risk factors which have higher adjuvant diagnostic value for lung cancer lymphatic metastasis.
Objective To evaluate the status of lymph node metastasis and reasonable procedure in gastric cancer. Methods The incidence of metastases from gastric cancer to various regional lymph node stations was studied in 1 505 patients with gastric cancer. The patients underwent surgical resection from January 1995 to December 2004.Results Lymph node metastasis were observed in 928 of 1 505 cases (61.7%). Lymph node metastasis frequency was found in groups No.1 （32.9%），No.3 （28.7%）， No.2 （20.4%）， and No.7 （18.6%） at upper third stomach cancer；in groups No.3 （32.5%）， No.4 （24.7%）， No.7 （20.6%）， and No.1 （17.3%） at middle third stomach cancer； in groups No.6 （33.7%）， No.3 （31.3%）， No.4 （25.6%）， and No.7 （21.5%） at lower third stomach cancer. Conclusions Distribution of metastatic lymph node is clearly related to the location of the tumor. Anatomical extent of lymph node metastases in gastric cancer provid surgical guidance for surgeons.
ObjectiveTo investigate the relationship between rules of local metastasis and the operation for rectal cancer. MethodsLiteratures about rules of local metastasis and operation for rectal cancer were reviewed and analysed. ResultsThe study of rules of local metastasis results in the change and refinement of the operation for rectal cancer. Conclusion With the development of basic research for rectal cancer,the operation for rectal cancer is changing and refining, and the result of the treatment is more favourable.
Objective To investigate the role of vascular endothelial growth factor-C (VEGF-C) and its receptors in the formation of lymphatic vessels and lymphatic metastasis in gastric cancer. Methods By the domestic and overseas literatures review, the expressions of VEGF-C and its receptors in gastric cancer, their role in tumor lymphatic metastasis and prospect in treatment of gastric cancer were summarized.Results There was a significant correlation between VEGF-C and its receptors and the formation of lymphatic vessels and lymphatic metastasis in gastric cancer. VEGF-C high expression might be an early event in lymphatic metastasis and could be considered as an independent predictive factor of lymphaticmicrometastasis. By inhibition of gastric cancer cell from secrete VEGF-C or blockage of the interaction of VEGF-C with VEGFR3, it was possible to inhibit tumor angiogenesis and the invasion and distant spread of cancer cells, thereby decreased mortality and improve survival. ConclusionVEGF-C and its receptors may promote the formation of lymphatic vessels and lymphatic metastasis in gastric cancer. It may be an effective way to gastric cancer for the treatments against VEGF-C and its receptors.
Objective To study the rule of lymphatic metastasis and to evaluate the extent of curative resection in advanced colorectal cancer. Methods One thousand and five lymph nodes from 114 consecutive patients with colorectal cancer underwent extended D3 resection were analyzed and classified as peritumor, longitudinal, and upward spread distribution. Results The metastatic rate and incidence of lymph node metastasis in peritumor, longitudinal as well as upward spread (N2 and N3) was 43.9% and 37.2%, 32.5% and 15.9% as well as 29.8% (19.3% and 10.5%) and 12.1% (16.6% and 7.8%) respectively. The distribution rate of metastatic lymph nodes was 17.5% and 23.5% in the longitudinal and upward spread respectively. In the longitudinal spread, most of lymph node metastasis was seen within 10 cm. Within 2 cm on the anal side in rectal cancer, the metastasis rate was 5.5%, and there was no metastasis in 2-4 cm. The lateral metastasis rate was 0%, 8.7% and 12.5% in the rectosigmoid (Rs), upper rectum (Ra) and lower rectum (Rb) respectively. Conclusion Advanced colorectal cancer tend to metastasize to longitudinal and upward lymph nodes. Jump metastasis is also a feature. In the lower rectal cancer within 6 cm from the anal verge or beyond pT3, there is a high risk of lateral metastasis. Extended D3 radical resection is necessary for colic cancer, but high ligation of the inferior mesenteric artery root as well as lateral lymphadenectomy and total mesenteric excision should also be performed for rectal cancer. There is no residual tumor tissue in the anastomosis when the excision distance is beyond 2 cm from the anal margin in rectal cancer.
ObjectiveTo investigate the rule of lymph node metastasis in early gastric cancer (EGC) so as to provide a reasonable treatment. MethodsWe retrospectively analyzed the clinical data of 118 EGC patients who had been treated from January 2006 to December 2012,and a total of 8 potential factors associated with occurrence of EGC were evaluated by univariate analysis and multivariate logistic regression analysis. ResultsThe univariate analysis showed that ulcer,tumor size,depth of invasion and lymphatic involvement were correlated with lymph node metastasis (P<0.05).Multivariate logistic regression analysis showed that presence of an ulcer (OR=2.872),tumor of 3.0 cm or larger than that (OR=2.351),tumor invasion into the submucous layer (OR=3.461) and invasion into the lymphatic tubes (OR=1.784) were found to be independent risk factors. ConclusionLymph node metastasis of EGC is correlated with many factors,so EGC treatment choice should be made reasonably based on strict screening to exclude various risk factors before taking surgery.
ObjectiveTo evaluate the pattern and predictive factors of regional lymph node metastasis in papillay thyroid carcinoma (PTC). MethodsThe clinical data of 223 patients with PTC whom suffered operation from Dec.2008 to Dec.2011 in our hospital were retrospective analyzed.The relationship among the lymph node metastasis of different area of the neck and patient's sex, age, preoperative TSH level, tumor size, multifocality, extracapsular spread, Hashimoto thyroiditis, nodular goiter, and the T classification of the tumors were analyzed. ResultsThe univariate analysis results showed that patient's age≥45 years old and associated with nodular goiter were statistically significantly related to central lymph node metastasis (P < 0.05), for lateral lymph node metastases, the multifocality were statistically significant (P < 0.05).The multivariate analysis results showed that patient's age≥45 years old and associated with nodular goiter were protective factors for central lymph node metastasis (P < 0.05), for lateral lymph node metastasis, the multifocality was risk factor (P < 0.05).Most of the lateral lymph node metastases were confined to levels Ⅱ-Ⅳ, and the incidence of level Ⅲ was as highest as 100%.When the skip metastasis, the levels Ⅱ-Ⅳ were the transfer of high incidence areas. ConclusionsWhen age < 45 years old of patients with PTC, the central neck dissection should be routine performed.The incidence of central lymph node metastasis will decrease if associated with nodular goiter.Because multifocality is a risk factor for lateral lymph node metastasis, careful inspection levels Ⅱ-Ⅳ should be performed during operation, espe-cially level Ⅲ lymph nodes.If skip metastasis is present, levels Ⅱ-Ⅳ dissection would be a proper treatment option.
ObjectiveTo analyze the relevant factors of levelⅡlymph node metastasis in papillary thyroid carci-noma. MethodsThe clinicopathologic data of 83 patients from November 2011 to March 2014 were analyzed retrospec-tively. All the primary tumors were papillary thyroid carcinoma located in unilateral lobe with ipsilateral lateral neck lymph node metastasis. The relationship of gender, age, microcarcinoma, superior pole involved by carcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis was analyzed. The calculated data were analyzed with Chi-Square test and there was significant difference when P < 0.05. ResultsThe rate of lymph node metastasis at levelⅡ, Ⅲ, Ⅳ, Ⅴ, Ⅵwas 51.8% (43/83), 78.3% (65/83), 71.7% (59/83), 4.8% (4/56), and 79.5% (66/83), respectively. There was no significant relationship of gender, age, microcarcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis (P > 0.05). The rate of lymph node metastasis at levelⅡwas significantly higher when superior pole involved by carcinoma (P < 0.05). ConclusionAmong the patients with papillary thyroid carcinoma, when superior pole involved by carcinoma the patient should be underwent selective neck dissection, the proper extent of dissection including levelⅡshould be performed.
ObjectiveTo observe the outcome of left lung cancer underwent surgical treatment and to analysis the relative risk factors for 4L lymphatic metastasis. MethodsWe retrospectively analyzed the clinical data of 643 lung cancer patients who had underwent mediastinal lymph node dissection intraoperatively in our hospital between January 2011 and December 2013. There were 430 males and 213 females with a mean age of 60.2±9.6 years(range 22 to 83 years), 260 patients had their 4L lymph node dissected, while other 383 patients did not. ResultsAmong 260 patients with 4L lymph node dissected, 44(16.9%) were found 4L lymph node metastasis pathologically. And the results indicated that station 5 lymph node metastasis(P=0.000, OR=12.108 with 95%CI 4.564 to 32.122), station 7 lymph node metastasis(P=0.000, OR=8.496 with 95%CI 2.594 to 27.827), station 8 lymph node metastasis(P=0.029, OR=24.915 with 95%CI 1.395 to 444.948), station 10 lymph node metastasis(P=0.014, OR=3.983, 95%CI 1.321 to 12.009) were independently associated with high risk for 4L lymph node metastasis. Conclusion4L lymphadenectomy should be performed for left invasive lung cancer regularly, especially for patients with hilar lymph node and other mediastinal lymph node metastasis.
ObjectiveTo systematically review the diagnostic value of ultrasound for breast cancer with axillary sentinel lymph nodes, so as to provide evidence for clinical decision-making. MethodsWe searched the databases including PubMed, EMbase, The Cochrane Library (Issue 12, 2013), CBM, CNKI, WanFang Data and VIP for studies about ultrasound in the diagnosis of breast cancer with axillary sentinel lymph nodes till December 31st, 2013. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and methodological quality of the included studies was evaluated. Meta-analysis was then conducted using Meta-Disc 1.4 software. ResultsA total of 12 studies involving 2 188 cases were included. The pooled results of meta-analysis showed that sensitivity and specificity were 0.75 (95%CI 0.72 to 0.77) and 0.91 (95%CI 0.89 to 0.92), respectively; positive likelihood ratio and negative likelihood ratio were 6.54 (95%CI 4.68 to 8.89) and 0.22 (95%CI 0.15 to 0.33), respectively; diagnostic odds ratio was 33.59 (95%CI 17.87 to 63.12); and the AUC was 0.934 3. ConclusionUltrasound is has relatively high value in diagnosis of breast cancer with axillary sentinel lymph nodes. However, due to the influence caused by the limited quality and various potential heterogeneity, more high quality RCTs with large sample size are needed to further verify the above conclusion.