Decrease in ICAM-1 expression on gastric cancer cells is correlated with lymph node metastasis

Background. Lymph node metastasis is a frequent type of metastasis in patients with gastric cancer. The mechanisms responsible for this type of metastasis, however, are not clearly understood. We hypothesize that the immunosurveillance system between cancer cells and lymphocytes may be associated with the lymph node metastatic process. In this study, we examined the correlation between lymph node metastasis and intercellular adhesion molecule-1 (ICAM-1), which mediates the immunosurveillance system between tumor cells and cytotoxic lymphocytes, in gastric cancer. Methods. One hundred and forty-three specimens resected from patients with gastric cancer were investigated by staining with a monoclonal antibody against ICAM-1. We studied the correlation between the expression of ICAM-1 and various clinicopathologic factors, as well as infiltration of tumor-infiltrating lymphocytes (TILs). Results. ICAM-1 expression on gastric cancer cells was significantly decreased in patients with lymph node metastasis. The infiltration of TILs was associated with ICAM-1 expression level. The prognosis of patients with ICAM-1-negative tumors was poorer than the prognosis of those with ICAM-1-positive tumors. Conclusions. These findings suggest that ICAM-1 expression on cancer cells is closely associated with lymph node metastasis in gastric cancer, under the influence of the host immunosurveillance system. Received on Aug. 20, 1999; accepted on Jan. 5, 2000     

早期胃癌的浸润深度与淋巴结转移关系

目的：探讨早期胃癌的浸润深度、肿瘤大小与淋巴结转移之间的相关性。方法：收集103例外科手术切除的早期胃癌,统计不同时期早期胃癌的检出率,分析其临床及病理特点。结果：103例早期胃癌中黏膜内癌（M）31例,仅有1例（3％）淋巴结转移,黏膜下癌（SM）有63例,淋巴结转移率为17％,其中SM1：16．1％,SM2：34％,SM3：35％;肿瘤最大直径超过2cn的淋巴结转移率（20％）较直径≤2cm者（8．8％）高;肉眼类型中Ⅱ型最多见,并淋巴结转移率也最高;组织类型中高分化腺癌最多,其次为低分化腺癌;且低分化腺癌淋巴结转移率高。结论：早期胃癌的淋巴结转移与肿瘤的浸润深度、肿瘤的大小、肉眼所见及组织类型有关。     

早期胃癌淋巴结转移及临床意义

淋巴结转移是影响早期胃癌手术方式选择和预后的重要因素,对其转移规律和特点的认识及检测方法的掌握对于合理开展缩小手术至关重要。运用免疫组化和逆转录聚合酶链反应技术对早期胃癌前哨淋巴结检测不仅可以了解淋巴结站的转移特点、规律,而且可以发现微转移,从而指导术中淋巴结清扫范围而选择合理术式,避免标准根治术淋巴结清扫和扩大的手术方式对机体造成不必要的损害,减少手术创伤和术后并发症的出现,提高患者术后生存质量。     

远端胃癌淋巴结转移规律及临床意义*

目的：探讨远端胃癌各组淋巴结转移的特点,指导远端胃癌根治手术中淋巴结清扫的范围。方法：回顾性分析2010年2 月至2014年9 月天津医科大学肿瘤医院远端胃癌患者773 例接受D 2（D 2 +）胃次全切除术的临床病理资料,分析其淋巴结转移特点。结果：773 例远端胃癌患者术后病理证实淋巴结转移为423 例（54.72%）,各组淋巴结中发生转移的患者所占比例由高至低依次为NO.6、NO.3、NO.4sb 、NO.5 组淋巴结。N 1 淋巴结转移率由高至低依次为NO.3、NO.6、NO.5、NO.4d 组淋巴结;N 2 淋巴结转移率由高至低依次为NO.8a 、NO.7、NO.1 组淋巴结。50.68% 的患者出现NO.8a 组淋巴结跳跃性转移。结论：远端胃癌根治性手术应注意NO.8a 淋巴结转移的可能性,必要时应适当扩大淋巴结的清扫范围。     

非小细胞肺癌患者淋巴结、外周血、骨髓微转移的MUC1基因诊断及临床意义

目的 :探讨非小细胞肺癌 (NSCLC)患者淋巴结、外周血、骨髓微转移的MUC1基因诊断的临床意义 ,以及三者微转移之间的相关性。方法 :应用逆转录聚合酶链反应 (RT PCR)技术 ,联合检测 31例肺癌患者和 10例肺良性病变患者的淋巴结、外周血和骨髓中MUC1基因mRNA表达。结果 :本实验建立的巢式RT PCR技术的敏感性达 10 -6。术前 10例患者外周血、7例患者骨髓检测到肺癌微转移。手术取 119枚淋巴结中 6 5枚检测到肺癌微转移。肺癌患者淋巴结、外周血、骨髓微转移阳性检出率分别为 5 4 .6 %、32 .3%、2 2 .6 % ,三者之间存在正相关(P <0 .0 5 )。结论 :RT PCR法是一种特异性、敏感性均较高的肿瘤微转移检测方法 ;MUC1基因mRNA可能是检测肺癌微转移的一个有价值的指标 ,为制定治疗方案和评估预后提供重要参考依据。     

乳腺癌前哨淋巴结和骨髓和外周血微小转移的联合检测

目的:探讨采用HE染色、免疫组织化学(IHC)和RTPCR等不同方法同时检测乳腺癌前哨淋巴结(SLN)、骨髓和外周血微小转移的灵敏度及其临床意义。方法:全身麻醉后先行骨髓穿刺和外周血采集,选用1%异硫蓝行前哨淋巴结活检(SLNB)后,采用HE染色、IHC和RTPCR等不同方法同时检测乳腺癌SLN、骨髓和外周血的微小转移。结果:腋窝淋巴结常规HE染色病理检查阴性患者38例,4例RTPCR技术和IHC方法检测SLN微小转移同时阳性,另外RTPCR技术还有6例KT19mRNA也表达,两种方法间显著相关,P=0003,但灵敏度上差异无统计学意义,P=0076;骨髓KT19mRNA阳性表达11例,明显高于外周血阳性表达3例,P=0018;RTPCR技术11例骨髓阳性表达,其中6例IHC检测也为阳性,二者间显著相关,P=0000,但灵敏度上差异无统计学意义,P=0169;38例骨髓和SLN中仅2例同时表达KT19mRNA,其间无显著相关,P=0690。结论:即使术前常规检查未发现腋窝淋巴结及远处转移,骨髓、外周血和淋巴结也可检出微小转移灶。由于骨髓和腋窝淋巴结不是同步出现,因此临床上需要检测多种组织、多个指标,才能更精确地对微小转移进行评价。     

Prognostic impact of positive lymph node ratio in gastric carcinoma

BACKGROUND AND OBJECTIVES: To evaluate the prognostic value of metastatic lymph node ratio in gastric carcinoma. METHODS: One hundred and sixty four patients who underwent D(2) dissection for gastric carcinoma at Ankara Oncology Hospital were reviewed retrospectively. The prognostic factors including Japanese classification, AJCC/UICC TNM classification and metastatic lymph node ratio (1-10% and >10%) were evaluated in univariate and multivariate Cox regression analysis. RESULTS: The multivariate analysis showed that Borrmann classification, pN-category of AJCC/UICC classification and metastatic lymph node ratio were the most significant prognostic factors and a higher hazard ratio was obtained for metastatic lymph node ratio than pN category of AJCC/UICC classification (4.5 vs. 11.4). When the metastatic ratio groups of 1-10% and >10% were subdivided into pN(1), pN(2) and pN(3) categories of the AJCC/UICC classification, there was no statistical difference between survival curves. When pN(1), pN(2) and pN(3) categories of the AJCC/UICC classification were subdivided into the ratio groups of 1-10% and >10%, the survival rate of ratio group 1-10% was better than ratio group >10%. CONCLUSION: With its simplicity and reproducibility, metastatic lymph node ratio can be used as a reliable prognostic indicator.     

早期胃癌的淋巴结转移规律及预后分析

目的 分析早期胃癌的临床病理特征与预后之间的关系及早期胃癌的淋巴结转移规律.方法 对1994年1月～2005年10月手术治疗并有完整资料的255例早期胃癌的临床病理学资料进行回顾性分析.结果 255例患者的总5年生存率为91.4%.单因素分析显示,肿瘤浸润深度、脉管瘤栓和区域淋巴结转移与患者术后生存率有关;而性别、年龄...     

Using nomogram,decision tree,and deep learning models to predict lymph node metastasis in patients with early gastric cancer: a multi-cohort study

The accurate assessment of lymph node metastasis (LNM) in patients with early gastric cancer is critical to the selection of the most appropriate surgical treatment. This study aims to develop an optimal LNM prediction model using different methods, including nomogram, Decision Tree, Naive Bayes, and deep learning methods. In this study, we included two independent datasets: the gastrectomy set (n=3158) and the endoscopic submucosal dissection (ESD) set (n=323). The nomogram, Decision Tree, Naive Bayes, and fully convolutional neural networks (FCNN) models were established based on logistic regression analysis of the development set. The predictive power of the LNM prediction models was revealed by time-dependent receiver operating characteristic (ROC) curves and calibration plots. We then used the ESD set as an external cohort to evaluate the models’ performance. In the gastrectomy set, multivariate analysis showed that gender (P=0.008), year when diagnosed (2006-2010 year, P=0.265; 2011-2015 year, P=0.001; and 2016-2020 year, P<0.001, respectively), tumor size (2-4 cm, P=0.001; and ≥4 cm, P<0.001, respectively), tumor grade (poorly-moderately, P=0.016; moderately, P<0.001; well-moderately, P<0.001; and well, P<0.001, respectively), vascular invasion (P<0.001), and pT stage (P<0.001) were independent risk factors for LNM in early gastric cancer. The area under the curve (AUC) for the validation set using the nomogram, Decision Tree, Naive Bayes, and FCNN models were 0.78, 0.76, 0.77, and 0.79, respectively. In conclusion, our multi-cohort study systematically investigated different LNM prediction methods for patients with early gastric cancer. These models were validated and shown to be reliable with AUC>0.76 for all. Specifically, the FCNN model showed the most accurate prediction of LNM risks in early gastric cancer patients with AUC=0.79. Based on the FCNN model, patients with LNM rates of >4.77% are strong candidates for gastrectomy rather than ESD surgery.     

Expression of SDF-1 alpha and nuclear CXCR4 predicts lymph node metastasis in colorectal cancer

Although stromal cell-derived factor (SDF)-1 alpha and its receptor CXCR4 are experimentally suggested to be involved in tumorigenicity, the clinicopathological significance of their expression in human disease is not fully understood. We examined SDF-1 alpha and CXCR4 expression in colorectal cancers (CRCs) and their related lymph nodes (LNs), and investigated its relationship to clinicopathological features. Specimens of 60 primary CRCs and 27 related LNs were examined immunohistochemically for not only positivity but also immunostaining patterns for SDF-1 alpha and CXCR4. The relationships between clinicopathological features and SDF-1 alpha or CXCR4 expression were then analysed. Stromal cell-derived factor-1 alpha and CXCR4 expression were significantly associated with LN metastasis, tumour stage, and survival of CRC patients. Twenty-nine of 47 CXCR4-positive CRCs (61.7%) showed clear CXCR4 immunoreactivity in the nucleus and a weak signal in the cytoplasm (nuclear type), whereas others showed no nuclear immunoreactivity but a diffuse signal in the cytoplasm and at the plasma membrane (cytomembrane type). Colorectal cancer patients with nuclear CXCR4 expression showed significantly more frequent LN metastasis than did those with cytomembrane expression. Colorectal cancer patients with nuclear CXCR4 expression in the primary lesion frequently had cytomembrane CXCR4-positive tumours in their LNs. In conclusion, expression of SDF-1 alpha and nuclear CXCR4 predicts LN metastasis in CRCs.     

胃癌淋巴结转移与预后的关系

目的：探讨胃癌淋巴结转移与预后的关系,为胃癌的手术治疗提供依据。方法：回顾性分析2000年-2004年间住院并行手术治疗的胃癌患者361例,建立数据库用SPSS13．0统计软件分析。结果：Logistic多因素回归分析显示胃癌肿瘤大小、浸润深度与淋巴结转移有关（P〈0．01）;Kaplan—Meier生存分析显示淋巴结转移与胃癌预后相关（P〈0．05）;而在相同浸润深度时,淋巴结转移与胃癌预后无关（P〉0．05）。结论：对于浸润深度相同,而淋巴结转移程度不同的胃癌,积极手术治疗能取得同样的治疗效果。     

胃癌的淋巴结转移与清扫范围关系的探讨

目的：探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义。方法：收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系。结果：103例患者胃癌淋巴结转移率为68.9%（71/103）。随着肿瘤直径的增加,淋巴结转移率（度）也增高（P〈0.05）;临床分期中,胃癌的淋巴结转移率（度）随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率（度）均低于其它期（P〈0.01）;Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%（40/49）,高于其它型（P〈0.05）,而Ⅳ型患者淋巴结转移度32.4%（161/497）最高。结论：淋巴结转移率和转移度随着胃癌的临床进展而增高。合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性。     

胃癌的淋巴结转移与清扫范围关系的探讨

目的:探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义.方法:收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系.结果:103例患者胃癌淋巴结转移率为68.9%(71/103).随着肿瘤直径的增加,淋巴结转移率(度)也增高(P<0.05);临床分期中,胃癌的淋巴结转移率(度)随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率(度)均低于其它期 (P<0.01);Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%(40/49),高于其它型(P<0.05),而Ⅳ型患者淋巴结转移度32.4%(161/497)最高.结论:淋巴结转移率和转移度随着胃癌的临床进展而增高.合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性.     

Prognostic role of lymph node metastasis in early gastric cancer

Objective： To clarify the relationship between clinicopathological features and lymph node metastasis and to propose the potential indications of lymph node metastasis for prognosis in early gaswic cancer （EGC） patients. Methods： We retrospectively observed 226 EGC patients with lymph node resection, and analyzed the associations between lymph node metastasis and clinicopathological parameters using the chi-square test in univariate analysis and logistic regression analysis in multivariate analysis. Overall survival analysis was determined using the Kaplan-Meier and log-rank test. We conducted multivariate prognosis analysis using the Cox proportional hazards model. Results： Of all the EGC patients, 7.5% （17/226） were histologically shown to have lymph node metastasis. The differentiation, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in EGC. The 5- and 10-year survival rates were significantly lower in patients with lymph node metastasis than in those without and the patients also had shorter progress-free survival time. Lymph node metastasis and tumor size were independent prognostic factors for EGC. The status of the lymph nodes was a significant factor in predicting recurrence or metastasis after surgery. Conclusions： The undifferentiated carcinoma and lymphovascular and/or submucosal invasion were associated with a higher incidence of lymph node metastasis in EGC patients, whom need to perform subsequent D2 lymphadenectomy or laparoscopic lymph node dissection and more rigorous follow-up or additional chemotherapy/radiation after D2 gastrectomy for poor prognosis and high recurrence/metastasis rate.     

Downstaging of lymph node metastasis after neoadjuvant intraperitoneal and systemic chemotherapy in gastric carcinoma with peritoneal metastasis

PurposeThe aim of the present study was to evaluate the clinical features and prognosis of lymph node metastasis (LNM) in gastric cancer patients with peritoneal metastasis (PM) after neoadjuvant intraperitoneal and systemic chemotherapy.MethodsA total of 69 gastric cancer patients with PM and LNM who received neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) of intraperitoneal docetaxel (DXT) and cisplatin (CDDP); intravenous chemotherapy of DXT and CDDP and oral S-1in Kishiwada Tokushukai Hospital between January 2008 and February 2017. After surgical resection, the response of LNMs was studied to confirm the effect of NIPS on LNMs.ResultsAfter NIPS, 197 lymph nodes (LNs) (42.5%) were graded as G3, the progression in LNMs were significantly better than in the primary tumors. Until the last follow-up, 1-year overall survival rate was 82.6%, and the median survival period was 22.0 ± 3.7 months. In the group of patients who had achieved a more than 50% G3 grade of the response of LNMs, the median survival period is 38 months; in the less than 50% G3 grade group, it is 14 months, that is a significantly different result. Multivariate analyses showed that the factors PCI, Post-therapeutic N status and response of the LNMs were found to be as independent prognostic factors.ConclusionDownstaging of LNMs were achieved in patients of gastric cancer with PM who received NIPS. Downstaging of LNMs after NIPS is related with the prognosis of gastric cancer and should be valued in subsequent surgery for gastric cancer with peritoneal and lymph nodes metastasis.     

Pattern of No. 12a lymph node metastasis in gastric cancer

Objective:The current standard D2 lymphadenectomy for gastric cancer(GC)includes dissection of lymph nodes(LNs)along the proper hepatic artery(No.12 a),however,the survival benefit remains controversial.The purpose of this study was to evaluate the pattern of No.12 a LN metastasis(LNM)in GC and explore the indications for No.12 a LN dissection.Methods:Medical records of 413 consecutive GC patients who underwent curative surgery in Zhongshan Hospital,Fudan University between January 2015 and December 2018 were enrolled and reviewed retrospectively.The correlation between No.12 a LNM and clinicopathologic characteristics of patients was analyzed.Results:The overall incidence of No.12 a LNM was 2.67%(11/413).Tumor location(P=0.012),depth of tumor infiltration(P<0.01)and N stage(P=0.018)were significant factors associated with No.12 a LNM.All the tumors with No.12 a LNM involved the lower third of the stomach and were in T3-4 stages.Patients with No.12 a LNM had extensive LNM than those without(20.91±4.25 vs.5.0±0.54,P<0.001).For advanced GC patients(stage III/IV)with tumors involving the lower third of the stomach,the incidence of No.12 a LNM increased to 10.7%(11/103).Patients with No.12 a LNM had a significantly poorer recurrence-free survival(RFS)(P=0.005)and overall survival(OS)(P=0.017).According to the result of multivariable Cox regression,No.12 a LNM was not an independent impact factor on RFS and OS.Conclusions:The overall incidence of No.12 a LNM was low but it was much higher in GC patients who had very advanced tumors involving the lower third of the stomach.No.12 a LN dissection should be considered for these patients to improve the survival outcomes.