ObjectiveTo analyze the characteristics and risk factors of lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC).MethodsThe clinical data of 407 patients with ESCC who underwent radical resection of esophageal carcinoma from December 2012 to October 2018 in our hospital were retrospectively analyzed. There were 390 males and 17 females with a median age of 63 (38-82) years. Esophageal lesions were found in 26 patients of upper thoracic segment, 190 patients of middle thoracic segment and 191 patients of lower thoracic segment. ResultsAmong the patients, 232 (57.0%) were found to have cervical, thoracic and/or abdominal lymph node metastasis. The lymphatic metastasis rates of cervical, upper, middle, lower mediastinal nodes and abdominal nodes were 0.7%, 8.8%, 21.4%, 16.7% and 37.1%, respectively. The adjacent lymph node metastasis alone occurred in 50.0% patients, and the multistage or skip lymph node metastasis accounted for 29.3% and 20.7%, respectively. Multivariate analysis showed that the length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion were independent risk factors for lymph node metastasis.ConclusionThe rates of lymph node metastasis are similar in the upper, middle and lower thoracic ESCC. The main pattern of lymph node metastasis is the adjacent lymph node metastasis, followed by multistage and skip lymph node metastases. The length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion are independent factors for lymph node metastasis. The operation and dissection range should be selected according to the location of tumor and the characteristics of the lesion.
Objective To investigate the feasibility and clinical value of combined treatment for lung cancer with cerebral metastasis. Methods From May 1999 to May 2005, twentyone patients diagnosed lung cancer with cerebral metastasis received treatment in our hospital. The management consists of cerebral lesion resection, chemotherapy, lung cancer resection and chemotherapy or radiotherapy. Then evaluate the short-term and long-term outcome. Results No severe complications occurred in hospital. The 1-, 2-, and 3-year survival rates were 75.0%(12/16), 37.5%(6/16), and 12.5%(2/16) respectively. Life quality was promoted significantly. Conclusion Although lung cancer with cerebral metastasis is classified as stage Ⅳ,the effect of combined treatment is favorable because of the special metastatic position. But the choice of the patient is important.
Objective To investigate the influence of cationic liposomemediated endostatin gene on colorectal cancer liver metastasis. Methods Animal model for colorectal carcinoma liver metastasis were established. The plasmid expressing endostatin genelipofectAMINE were injected in vein. Results After cationic liposomemediated endostatin gene were injected in vein, the incidence of liver metastasis and mean numbers of liver tumors were decreased, survival time of animal was significantly longer. Conclusion Intravenous injection of cationic liposomemediated endostatin gene can control the development of colorectal cancer liver metastasis effectively.
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.
ObjectiveTo identify the risk factors of bone metastasis in breast cancer and construct a predictive model. MethodsThe data of breast cancer patients met inclusion and exclusion criteria from 2010 to 2015 were obtained from the SEER*Stat database. Additionally, the data of breast cancer patients diagnosed with distant metastasis in the Affiliated Hospital of Southwest Medical University from 2021 to 2023 were collected. The patients from the SEER database were randomly divided into training (70%) and validation (30%) sets using R software, and the breast cancer patients from the Affiliated Hospital of Southwest Medical University were included in the validation set. The univariate and multivariate logistic regressions were used to identify risk factors of breast cancer bone metastasis. A nomogram predictive model was then constructed based on these factors. The predictive effect of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis. ResultsThe study included 8 637 breast cancer patients, with 5 998 in the training set and 2 639 (including 68 patients in the Affiliated Hospital of Southwest Medical University) in the validation set. The statistical differences in the race and N stage were observed between the training and validation sets (P<0.05). The multivariate logistic regression analysis revealed that being of white race, having a low histological grade (Ⅰ–Ⅱ), positive estrogen and progesterone receptors status, negative human epidermal growth factor receptor 2 status, and non-undergoing surgery for the primary breast cancer site increased the risk of breast cancer bone metastasis (P<0.05). The nomogram based on these risk factors showed that the AUC (95% CI) of the training and validation sets was 0.676 (0.533, 0.744) and 0.690 (0.549, 0.739), respectively. The internal calibration using 1 000 Bootstrap samples demonstrated that the calibration curves for both sets closely approximated the ideal 45-degree reference line. The decision curve analysis indicated a stronger clinical utility within a certain probability threshold range. ConclusionsThis study constructs a nomogram predictive model based on factors related to the risk of breast cancer bone metastasis, which demonstrates a good consistency between actual and predicted outcomes in both training and validation sets. The nomogram shows a stronger clinical utility, but further analysis is needed to understand the reasons of the lower differentiation of nomogram in both sets.
Objective To review the recent studies on the suppressing function of breast cancer metastasis suppressor 1 (BRMS1) in breast cancer metastasis. Methods The recent literatures on the mechanisms of BRMS1 in the breast cancer that were published in and abroad were reviewed and summarized. Results BRMS1, similar to the other anti-metastasis genes, only suppresses the metastasis of breast cancer cells but has nothing to do with the growth of tumor. BRMS1 could suppress metastasis of tumor cells by reestablishing both the homospecific and the heterospecific gap junctional intercellular comminications (GJIC) and by altering the expressions of relevant metastasis genes in the breast cancer. Conclusion Further studies on BRMS1 may be helpful to understand the metastasis of breast cancer, which may provide a new way for the diagnosis and treatment of breast cancer.
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 explore the value on excision of subpyloric (No.6 group) lymph nodes of stomach by detection of metastatic rate and metastasis of lymph nodes of No.6 group and its subgroups. MethodsThe clinical data including complete information on No.6 group and its subgroups lymph nodes in 80 patients underwent gastrectomy and subpyloric lymph nodes dissection for gastric cancer from January 2006 to December 2009 were retrospectively analyzed. Referring to the right gastroepiploic vein, the No.6 lymph nodes were divided into three subgroups (No.6a, No.6b, and No.6c subgroup), and the relationship between the metastasis of No.6 lymph nodes and clinicopathologic features as well as the metastasis of No.7, No.8a， and No.9 lymph nodes were analyzed by logistic regression analysis. ResultsThe metastatic rate of No.6 group lymph nodes was 41.3% (33/80) and with 26.0% (108/415) of the resected lymph nodes involved. The metastatic rate of lymph nodes in No.6a subgroup (7.5%, 6/80) was significantly lower than that in No.6b (16.3%, 13/80) and No.6c subgroup (36.3%, 29/80), Plt;0.001. The metastasis of the resected lymph nodes in No.6a, No.6b, and No.6c subgroup was 25.0% (8/32), 17.6% (13/74), and 28.2% (87/309), respectively, and the difference was not significant (P=0.292). The metastasis of lymph nodes in No.6a subgroup was correlated to T stage (P=0.042) and N stage (P=0.006). The metastasis of lymph nodes in No.6b subgroup was correlated to N stage (P=0.002) and TNM stage (P=0.013). The metastasis of lymph nodes in No.6c subgroup was correlated to differentiation degree of tumor (P=0.008), T stage (P=0.003), N stage (P=0.000), and TNM stage (P=0.000). The logistic regression analysis showed that the metastasis of lymph nodes was correlated to the metastasis of No.8a lymph nodes (P=0.023) and N stage (P=0.002) in No.6 group, the metastasis of No.8a lymph nodes (P=0.018) in No.6a subgroup, N stage (P=0.005) in No.6b subgroup, and the metastasis of No.8a lymph nodes (P=0.016) and N stage (P=0.004) in No.6c subgroup. ConclusionAttentions should be paid to the complete dissection of subpyloric lymph nodes in gastric cancer surgery, especially for the lymph nodes of No.6a and No.6b subgroups.
摘要:目的:探讨血清CA153和BAKP在乳腺癌骨转移显像诊断中的应用。方法:对92例乳腺癌患者的核素骨显像结果、血清CA153和BAKP结果进行回顾性研究。结果:①血清CA15-3和B-AKP的值随着骨转移分期的增高而逐步升高,且差异显著(Plt;0. 01);②血清CA15-3和B-AKP与骨转移的数目呈正相关;③血清CA15-3gt;25 U/mL时,骨转移的阳性率为63.3%,血清CA15-3lt;25 U/mL时,骨转移的阴性预测值为94. 5%;血清B-AKPgt;20 U/L时,骨转移的阳性率为59. 6%时,骨转移的阴性预测值为73.5%;当血清CA15-3lt;25 U/mL同时B-AKPlt;20 U/L时,骨转移的阴性预测值为100%。结论:血清CA15-3和BAKP测定在乳腺癌骨显像诊断中具有重要的应用价值。Abstract: Objective: To evaluate the diagnosis value of serum CA153 and BAKP measurements for scanning bone metastatic images in patients with mammary Cancer. Methods: Retrospective study on the bone scan images and serum CA153 (with CLIA) and bone alkaline phosphatase (BAKP, with ELISA) levels were performed in 92 patients with confirmed mammary gland cancer. Results: ①The serum levels of CA153 and BAKP were increased step by step along with the advancement of bone metastatic grading from M0 to M3 with significant difference between values in successive gradings (Plt;0. 01).②The levels of CA153 and BAKP were significantly positively correlated. ③With serum CA153gt;25 U/mL the positive rate of bone metastasiswas 63.2%, with CA153lt;25 U/mL the negativepredictive value of bone metastasis was 94.5%, with BAKPgt;20 U/L,the positive rate of bone metastasis was 596%, with BAKPlt;20 U/L, the negative predictive value of bone metastasis was 73. 5%.However with Serum CA153lt;25 U/mL and BAKPlt;20 U/L, the negative predictive value of bone metastasis was100%. Conclusion: The combined measurement of the serum CA153 and BAKP levels would play an important role for diagnosis of bone scan images in patients with prostate cancer.
Objective To study the necessity and feasibility of No.12b lymph node dissection in D2 lymphadenectomy for advanced distal gastric cancer, and the relation between No.12b lymph node metastasis and clinicopathologic factors. Methods Clinical data of sixty cases of advanced distal gastric cancer receiving D2 or D2+ radical correction were collected retrospectively, both of which were all plus No.12b lymph node dissections. The relationships between No.12b lymph node metastasis and clinicopathologic factors were analyzed. Results No death attributed to operation or severe operative complications were found. There were 12 cases (20.00%) with No.12b lymph node metastasis. The rates of No.12b lymph node metastasis in Borrmann Ⅲ-Ⅳ types, N2-3 of lymph node metastasis and T3-4 of tumor infiltration were 31.25% (10/32), 30.30% (10/33) and 29.73% (11/37), which were significantly higher than those in Borrmann Ⅰ-Ⅱ types 〔7.14% （2/28）〕, N0-1 〔7.41% （2/27）〕 and T1-2 〔4.35% （1/23）〕 respectively (Plt;0.05). There was no relationship between tumor size and No.12b lymph node metastasis. Conclusions No.12b lymph node dissection is safe and feasible for advanced distal gastric cancer. Further perspective studies on No.12b lymph node dissection influence on prognosis in more cases are required.