Prognostic significance of the endoscopic ultrasound defined lymph node metastasis count in esophageal cancer

The key prognostic factor which predicts outcome after esophagectomy for cancer is the number of malignant lymph node metastases, but data regarding the accuracy of endoscopic ultrasound (EUS) in determining and predicting the metastatic lymph node count preoperatively are limited. The aim of this study was to assess the prognostic significance of EUS defined lymph node metastasis count (eLNMC) in patients diagnosed with esophageal cancer. Two hundred and sixty‐seven consecutive patients (median age 63 years, 187 months) underwent specialist EUS followed by stage directed multidisciplinary treatment (183 esophagectomy [64 neoadjuvant chemotherapy, 19 neoadjuvant chemoradiotherapy], 79 definitive chemoradiotherapy, and 5 palliative therapy). The eLNMC was subdivided into four groups (0, 1, 2 to 4, >4) and the primary measure of outcome was survival. Survival was related to EUS tumor (T) stage (P < 0.0001), EUS node (N) stage (P < 0.0001), EUS tumor length (p < 0.0001), and eLNMC (P < 0.0001). Multivariable analysis revealed EUS tumor length (hazard ratio [HR] 1.071, 95% CI 1.008–1.138, P= 0.027) and eLNMC (HR 1.302, 95% CI 1.133–1.496, P= 0.0001) to be significantly and independently associated with survival. Median and 2‐year survival for patients with 0, 1, 2–4, and >4 lymph node metastases were: 44 months and 71%, 36 months and 59%, 24 months and 50%, and 17 months and 32%, respectively. The total number of EUS defined lymph node metastases was an important and significant prognostic indicator.     

Prognostic significance of perigastric lymph nodes metastases on survival in patients with thoracic esophageal cancer

Several publications have showed that the number of metastatic lymph node (LN) should be taken into consideration in nodal category of esophageal cancer, but seldom considered extent of involved regional LNs. The aim of this study is to evaluate the significance of the extent of regional LN metastasis on survival in patients with esophageal cancer. A total of 245 thoracic esophageal cancer patients underwent transthoracic esophagectomy with standard lymphadenectomy between January 2000 and December 2006 were included in the study. Data including demographic factors, pathologic findings, LN parameters and survival outcomes were collected. The survival experience was depicted using Kaplan‐Meier method. A multivariate Cox proportional hazard model was used to screen the significant prognostic factors. The univariate analysis to further explore the significant prognostic factor was done by log‐rank test. After a median follow‐up of 53.2 months, the 5‐year survival rate was 46.3% for the entire cohort. Cox model regression indicated that the LN status and perigastric nodal status, aside from residual tumor status, histological tumor type and depth of invasion, were the independent prognostic factors. Patients without LN metastasis had better 5‐year survival than those with positive nodes (64.2% vs. 18.9%, X²= 35.875, P < 0.001). However, For those patients with nodal involvement, there was no difference in 5‐year survival between patients with involved nodes <3 and ≥3 (27.8% vs. 0%, X²= 0.925, P= 0.336). When considering the location of LN metastasis, patients could be further stratified according to whether the perigastric nodes were involved or not (37.5% vs. 10.0%, X²= 4.295, P= 0.038). In conclusion, involved LN number had no prognostic implication in nodal involved patients based on our data. Whereas, perigastric nodal involvement should be used to refine the N category (N0, no nodal metastasis, N1, non‐perigastric node metastasis, N2, perigastric node metastasis) for the future esophageal cancer staging criteria.     

Reduction rate of lymph node metastasis as a significant prognostic factor in esophageal cancer patients treated with neoadjuvant chemoradiation therapy

Tumor regression is used widely as a measure of tumor response following radiation therapy or chemoradiation therapy (CRT). In cases of esophageal cancer, a different pattern of tumor shrinkage is often observed between primary tumors and metastatic lymph nodes (MLNs). Regression of MLNs surrounded by normal tissue may be a more direct measure of the response to CRT than regression of a primary tumor as exfoliative mechanical clearance does not participate in shrinkage of MLNs. In this study we evaluated the significance of the reduction rate (RR) of MLNs as a prognostic factor in esophageal cancer patients treated with neoadjuvant CRT. Forty-two patients with marked MLNs were selected from 93 patients with esophageal carcinoma who had received neoadjuvant CRT. The RRs of the primary tumor and the MLNs were calculated from computed tomography scans. In 20 patients, surgical resection was carried out following CRT. Univariate analysis was used to determine which of the following variables were related to survival: size of the primary tumor and MLNs; RRs of both lesions; degree of lymph node (LN) metastasis; clinical stage; and surgical resection. Multivariate analysis was then performed to assess the prognostic relevance of each variable. The primary tumor was larger than the MLNs in 69% of patients before CRT and in 40% of patients after CRT. In 79% of the patients, the RR of the primary tumor was greater than the RR of the MLNs. The results of the univariate analyses showed that a high RR of the MLNs and surgical resection after CRT were associated with significantly improved survival. The multivariate analysis demonstrated that the RR of MLNs had the strongest influence on survival. The RR of LN metastasis should be evaluated as an important prognostic predictor in patients with marked LN metastasis of esophageal cancer treated with CRT.     

Prediction of lymph node metastasis and sentinel node navigation surgery for patients with early-stage gastric cancer

Accurate prediction of lymph node (LN) status is crucially important for appropriate treatment planning in patients with early gastric cancer (EGC). However, consensus on patient and tumor characteristics associated with LN metastasis are yet to be reached. Through systematic search, we identified several independent variables associated with LN metastasis in EGC, which should be included in future research to assess which of these variables remain as significant predictors of LN metastasis. On the other hand, even if we use these promising parameters, we should realize the limitation and the difficulty of predicting LN metastasis accurately. The sentinel LN (SLN) is defined as first possible site to receive cancer cells along the route of lymphatic drainage from the primary tumor. The absence of metastasis in SLN is believed to correlate with the absence of metastasis in downstream LNs. In this review, we have attempted to focus on several independent parameters which have close relationship between tumor and LN metastasis in EGC. In addition, we evaluated the history of sentinel node navigation surgery and the usefulness for EGC.     

食管癌术后纵隔淋巴结转移两种疗法疗效比较

目的对食管癌术后纵隔淋巴结转移患者,比较三维调强适形放疗与常规放疗的疗效。方法分析2003年1月~2008年12月间安徽省立医院肿瘤放疗科收治的102例食管癌术后纵隔淋巴结转移患者,按不同标准对其分类入组并统计生存时间,对所得数据进行Log-Rank单因素分析。结果 102例患者中,调强放疗组局控率为87.2%,常规放疗组局控率为74.5%,局控率差异P〈0.05,放疗结束后13个月,两组生存率分别为46.0%、47%,P〈0.05。结论对食管癌术后纵隔淋巴结转移患者：三维调强适形放疗肿瘤局控率高于常规放疗,三维调强适形放疗远期生存率与常规放疗无差异。     

Prognosis of patients with gastric cancer and solitary lymph node metastasis

AIM:To investigate the relationship of solitary lymph node metastasis(SLNM)and age with patient survival in gastric cancer(GC).METHODS:The medical records databases of China’s Beijing Cancer Hospital at the Peking University School of Oncology and Shanghai Tenth People’s Hospital affiliated to Tongji University were searched retrospectively to identify patients with histologically proven GC and SLNM who underwent surgical resection between October 2003 and December 2012.Patients with distant metastasis or gastric stump carcinoma following resection for benign disease were excluded from the analysis.In total,936 patients with GC+SLNM were selected for analysis and the recorded parameters of clinicopathological disease and follow-up(range:13-2925 d)were collected.The Kaplan-Meier method was used to stratify patients by age(≤50 years-old,n=198;50-64 years-old,n=321;≥65 years-old,n=446)and by metastatic lymph node ratio[MLR<0.04(1/25),n=180;0.04-0.06(1/25-1/15),n=687;≥0.06(1/15),n=98]for 5-year survival analysis.The significance of intergroup differences between the survival curves was assessed by a log-rank test. RESULTS:The 5-year survival rate of the entire GC+SLNM patient population was 49.9%.Stratification analysis showed significant differences in survival time(post-operative days)according to age:≤50 yearsold:950.7±79.0 vs 50-64 years-old:1697.8±65.9 vs≥65 years-old:1996.2±57.6,all P<0.05.In addition,younger age(≤50 years-old)correlated significantly with mean survival time(r=0.367,P<0.001).Stratification analysis also indicated an inverse relationship between increasing MLR and shorter survival time:<0.04:52.8%and 0.04-0.06:51.1%vs≥0.06:40.5%,P<0.05.The patients with the shortest survival times and rates were younger and had a high MLR(≥0.06):≤50 years-old:496.4±133.0 and 0.0%vs 50-65 years-old:1180.9±201.8 and 21.4%vs≥65 years-old:1538.4±72.4 and 37.3%,all P<0.05.The same significant trend in shorter survival times and rates for younger patients was seen with     

Risk factors of non-sentinel lymph node metastasis in 443 breast cancer patients with sentinel lymph node-positive

Axillary lymph node dissection is the standard surgical procedure for breast cancer patients with sentinel lymph node (SLN) positive. In clinical practice, axillary lymph node dissection may be an unnecessary treatment for some breast cancer patients with non-sentinel lymph node (NSLN) negative. The aim of this study was to analyze the risk factors of NSLN metastasis in breast cancer patients with SLN positive. Four hundred fifty-six clinical early stage breast cancer patients with SLN positive were collected and analyzed in the oncological surgery department of Fujian Provincial Hospital during 2013 to 2018. All these patients underwent surgical treatment. The average age and tumor size of 443 patients with SLN positive breast cancer were (49.8 ± 10.8) years and (2.42 ± 0.94) cm. Univariate analysis showed that the size of primary tumor, the number of positive SLN, the number of negative SLN, the ratio of positive SLNs, and the type of metastases in SLN were the influencing factors of NSLN metastasis. Multivariate regression analysis showed that primary tumor size T > 2 cm (P < .001, OR = 2.609), the positive number of SLNs ≥3 (P = .002, OR = 5.435), the ratio of positive SLNs ≥ 50% (P = .017, OR = 1.770), and SLN macrometastases (P < 0.001, OR = 16.099) were independent risk factors for NSLN metastasis. Combined with the 4 independent risk factors, the area under the curve to predict NSLN metastasis was 0.747 > 0.7. For clinical early breast cancer with positive SLN, primary tumor size T > 2 cm,the positive number of SLNs ≥ 3, the ratio of positive SLNs ≥ 50%, and SLN macrometastases could predict NSLN metastasis well, and guide surgery to avoid overtreatment.     

子宫内膜癌淋巴结转移规律探讨

目的　探讨子宫内膜癌淋巴结转移规律。方法　对接受全子宫、盆腔淋巴结切除术的160例子宫内膜癌患者,观察并记录其肿瘤所处子宫腔位置、子宫肌层浸润深度、分期、病理类型、细胞学分级及切除淋巴结位置、总数及阳性淋巴结数,并进行相关分析。结果 肿瘤位于宫底部、体部、累及宫颈者淋巴结转移率分别为19.2％、21.2％、35.9％,均以髂外淋巴结转移最常见。病灶局限于宫底、宫体部者多为髂外、闭孔淋巴结转移;累及宫颈者以髂外、髂总淋转移为常见;前者髂总淋巴结转移率为25％,后者为71.3％,P<0.01。所有腹主动脉旁淋巴结阳性及累及宫颈者的髂总淋巴结均有转移,而病灶限于宫体的腹主动脉旁淋巴结转移者仅有30％髂总淋巴结阳性。肿瘤的肌层浸润深度、病理类型及分化程度与盆腔淋巴结转移密切相关。结论 宫体部子宫内膜癌可直接或由宫颈转移至髂外淋巴结,宫颈受累者最易发生髂总和髂外淋巴结转移。宫颈受累者髂总淋巴结可作为腹主动脉旁淋巴结的前哨淋巴结。     

Effects of neoadjuvant chemotherapy on primary tumor and lymph node metastasis in esophageal squamous cell carcinoma: additive association with prognosis

SUMMARY.  Neoadjuvant chemotherapy (NACT) is widely used to treat esophageal squamous cell carcinoma with lymph node metastasis (ESCC). However, NACT frequently has differential effects on primary tumor (PT) and lymph node metastasis (LNM). The clinical significance of this phenomenon remains unclear. Reduction in tumor size of PT and LNM was evaluated separately in 47 node-positive ESCC patients undergoing NACT, followed by surgical resection. We analyzed the prognostic significance and various clinicopathological parameters. NACT resulted in an average reduction rate of 45.5% for PT and 36.6% for LNM; the correlation between these rates was weak but significant ( r ² = 0.122, P  = 0.016). The reduction rates in both PT and LNM were significant prognostic factors, with the maximal significance with cut-off at 30% size reduction for PT (3-year survival, 47.3 vs. 8.3%, P  = 0.0004) and 20% for LNM (51.3 vs . 7.1%, P  = 0.0013). When these cut-off values were used to define NACT response, 28 patients (59%) were deemed responders for both PT and LNM, while 7 (15%) were nonresponders for both, and the response was inconsistent in 12 patients (26%). Only both PT/LNM responders showed good survival rates, with the remaining categories showing poor survival (3-year survival 60.5 vs . 5.3% P  < 0.0001). Multivariate analysis identified neither the PT nor the LNM response alone as an independent prognostic factor; however the combined PT/LNM response was identified as an independent prognostic factor (hazard ratio [HR] 2.861, P  = 0.0255) in addition to the number of histological lymph node metastases (HR 2.551, P  = 0.0328). The response to NACT in LNM and PT correlates closely with postoperative survival. A good response in both enhances the postoperative prognosis.     

The number of lymph node metastases influences survival and International Union Against Cancer tumor–node–metastasis classification for esophageal squamous cell carcinoma

To study the influence of the number of metastatic lymph nodes (LNs) on survival and International Union Against Cancer tumor–node–metastasis (TNM) classification for esophageal carcinoma. The clinicopathological data on 1146 patients with esophageal squamous cell carcinoma who had undergone an esophagectomy were retrospectively studied. Survival was analyzed by the Kaplan–Meier method. By subclassifying the nodes (N) category according to the number of metastatic LNs as: N₀ for no LN metastases; N₁₍₁₎ for only one positive node; and N₁₍₂₎ for ≥2 positive nodes. TNM staging was refined as stage II_a (T_2‐3N₀M₀), stage II_b (T₁N₁M₀ and T₂N₁₍₁₎M₀), stage IIIa (T₂N₁₍₂₎M₀ and T₃N₁₍₁₎M₀), and stage III_b (T₃N₁₍₂₎M₀ and T₄N_anyM₀), and the survival was analyzed. LN metastases was found in 380 of 1146 (33.2%) treated esophageal cancer patients. In 4270 LNs harvested, metastases was detected in 807 (18.9%). The 5‐year survival rates of the patients with 0, 1, and ≥2 positive nodes were 59.8, 33.4, and 9.4%, respectively. There was statistically significant difference among these three groups. The 5‐year survival of the patients in stages T₂N₁M₀ and T₃N₁M₀ was significantly higher in the N₁₍₁₎ group than in the N₁₍₂₎ group (41.5 vs 24.1%, and 31.2 vs 6.8%, P < 0.001). The 5‐year survival rates of the patients in refined stage II_a, II_b, III_a, and III_b were 57.1, 42.2, 28.6, and 8.5%, with significant difference existing in each stage groups. The number of positive LNs significantly influenced survival of the patients with esophageal cancer. Three grade classification (0, 1, ≥2 positive nodes) could quite well demonstrate the effect of the number of LN metastases and the survival. The refined TNM classification based on the number of LN metastases could better reflect the prognosis of esophageal cancer. Our results offer a strong rationale for refining the International Union Against Cancer TNM classification for esophageal carcinoma.     

Value of subcarinal lymph node dissection in esophageal cancer surgery: A case-control study

We investigated the value of subcarinal lymph node dissection in esophageal cancer surgery. Altogether, 240 patients with esophageal cancer admitted to our department between June 2012 and January 2016 were prospectively assigned to an experimental group (subcarinal lymph node dissection group, n = 120 cases) and a control group (uncleaned group, n = 120 cases). The number of subcarinal lymph nodes and the rate of subcarinal lymph node metastasis were determined, and the factors influencing subcarinal lymph node metastasis were analyzed using logistic regression in the experimental group. The operation time, postoperative complications, intraoperative blood loss, postoperative hospital stay, total postoperative hospital cost, and 5-year survival rate were compared between the 2 groups. In the experimental group, an average of 6.03 subcarinal lymph nodes were dissected, and the lymph node metastasis rate was 18.33%. The subcarinal lymph node metastasis rate in the experimental group was related to the size of the subcarinal lymph nodes, depth of tumor invasion, and tumor location. The 5-year survival rate was higher in the experimental group than in the control group (44.2% vs 30.0%, χ² = 6.407, P = .04). The subcarinal lymph node metastasis rate in patients with esophageal cancer is high. Patients with mid-thoracic esophageal cancers that infiltrate beyond the esophageal muscle layer with subcarinal lymph node size > 1.0 cm should undergo lymph node resection, despite increased operation time, incidence of postoperative pulmonary infection, hospitalization time, and total postoperative cost; lymph node resection may improve the 5-year survival rate.     

Alpha-fetoprotein-producing colon cancer with atypical bulky lymph node metastasis

INTRODUCTIONAlpha-fetoprotein (AFP)-producing colorectal cancer isextremely rare, and only ten cases have been described in the English literature[1]. All reported cases presented with lung and/or liver metastasis and had a very poor prognosis. We here re…     

MicroRNA expression profile in non‐cancerous colonic tissue associated with lymph node metastasis of colon cancer

OBJECTIVE: To identify microRNA expression patterns associated with the lymph node metastasis of colon cancer. METHODS: MicroRNA were isolated from six frozen non‐cancerous surrounding colonic tissues derived from stage II–III colon cancer patients with (n = 3) and without (n = 3) lymph node metastasis. We compared the microRNA expression profiles of the six non‐cancerous colonic tissues from two colon cancer patient groups; those with confirmed lymph node metastasis, termed the lymph node positive group, and those without detectable lymph node metastasis, termed the lymph node negative group. MicroRNA expression was analyzed with Agilent microarrays containing 723 human microRNA probes. We validated the expression level of differentially expressed microRNA using quantitative real‐time PCR analysis. RESULTS: Two microRNA (hsa‐miR‐129*, hsa‐miR‐137) were differentially expressed in the lymph node positive group compared with the lymph node negative group. The expression level of hsa‐miR‐137 was quantified via quantitative real‐time PCR analysis for validation. Hsa‐miR‐137 expression was significantly upregulated nearly 6.6‐fold in lymph node positive specimens (P = 0.036). The quantitative real‐time PCR result correlates with the microarray finding. CONCLUSION: The non‐cancerous colonic tissues from colon cancer patients with lymph node metastasis have a significantly different microRNA expression profile compared to that from colon cancer patients without lymph node metastasis. The differentially expressed microRNA could have relevance to the lymph node metastasis of colon cancer and may provide a simple profiling method to assist in identifying patients with lymph node metastasis. Besides, these data might offer new ideas for preventing and controlling lymphatic metastasis in colon cancer.     

Axillary lymph node metastasis following resection of abdominal wall laparoscopic port site recurrence of gallbladder cancer

Abdominal wall port site recurrence of gallbladder cancer is well described in the literature in patients that have undergone laparoscopic cholecystectomy with the incidental finding of a gallbladder cancer. The etiology and consequences of this type of metastatic recurrence are unclear. This report describes two cases with the unique sequelae of the interval development of nodal metastases to the axillary lymph nodes following resection of an abdominal wall laparoscopic port site recurrence of gallbladder cancer. The first case involves a patient who developed an isolated left axillary lymph node metastasis approximately 10 months after undergoing resection of a left-sided abdominal wall port site recurrence for a T2 gallbladder cancer. The original tumor had been found at laparoscopic cholecystectomy and definitively treated surgically approximately 3 years earlier. The second case involves a patient who developed isolated nodal metastases to the right axillary lymph nodes approximately 4 months after undergoing resection of right-sided abdominal wall port site recurrence, segment 4/5 hepatic resection, and portal lymphadenectomy for a T2 gallbladder cancer. This tumor had originally been found at laparoscopic cholecystectomy approximately 1 year earlier. These unique sequelae of the interval development of nodal metastases to the axillary lymph nodes demonstrated in both cases has not been previously reported.     

Tumor cell dissociation score highly correlates with lymph node metastasis in superficial esophageal carcinoma

BACKGROUND: It is still not clear which parameters are important for predicting the metastatic potential of superficial esophageal squamous cell carcinoma (SESCC). The purpose of the present paper was thus to investigate tumor cell dissociation (TCD) in SESCC as a predictive factor of lymph node metastasis. METHODS: Thirty-three SESCC were classified into four groups based on the depth of tumor invasion. Carcinomas not invading as far as the muscularis mucosa were classified as group A; carcinomas invading to the muscularis mucosa or less than one-third of the upper submucosa were classified as group B; those invading to the middle layer of the submucosa were classified as group C; and those invading one-third of the lower submucosa were classified as group D. The TCD score was calculated by dividing the length of the TCD region by the maximal longitudinal length of the area of invasion into or beyond the lamina propria, and multiplying by 100. E-cadherin expression of the carcinomas was investigated in the TCD area and the successive area of mucosal invasive carcinoma (SAM). RESULTS: The incidence of lymph node metastasis was 0% in group A, 10% in group B, 36.4% in group C and 57.1% in group D. The mean TCD scores (+/-SEM) of SESCC with lymph node metastasis were higher than that without (85.3 +/- 5.7, 16.3 +/- 3.9, respectively; P < 0.001). In group C, the TCD score of cases with lymph node metastases was higher than in those without lymph node metastasis (P < 0.001). E-cadherin expression was significantly reduced in the area of TCD compared with the SAM located over the TCD area (P < 0.001). CONCLUSIONS: The TCD score is an important predictive marker for lymph node metastasis in SESCC. Clinical evaluation of TCD scores in endoscopic mucosal resection (EMR) specimens would enable accurate prediction of lymph node metastasis and extend the indication of EMR treatment for SESCC.     

Advanced gastric cancer with multiple lymph node metastasis successfully treated with etoposide, adriamycin and cisplatin

Gastric cancer usually shows poor sensitivity to chemotherapy, and the presence of lymph node metastases is associated with extremely poor prognosis, especially when the number of such nodes is more than 10. We report here a case of advanced gastric cancer with histopathologically confirmed metastases in 15 regional lymph nodes, in which the recurrent tumor was sensitive to combination chemotherapy. Distal gastrectomy with lymphadenectomy was performed for the primary tumor. A hard (recurrent) tumor was detected in the upper abdomen 5 months postoperatively. Abdominal CT revealed two tumors measuring 3.5 x 1.8 and 3.3 x 2 cm in diameter at the front of the pancreatic head, which suggested recurrence. Etoposide, adriamycin and cisplatin (EAP) chemotherapy (20 mg/kg adriamycin, 100 mg/kg etoposide and 50 mg/kg cisplatin (CDDP)) was administered every 6 weeks. The tumors regressed and became undetectable on CT after four cycles. At that stage, CDDP was replaced with 400 mg/kg carboplatin, which was administered every 1 or 2 months. The patient had no recurrence 8 years after surgery. For treatment of advanced gastric cancer with multiple lymph node metastases, a wide resection of the tumor should be performed followed by treatment of the residual tumor cells with a suitable combination chemotherapy taking into consideration the characteristics of the tumor and the condition of the host. We present a patient with gastric cancer and histopathologically confirmed metastases in 15 regional lymph nodes, who was successfully treated by surgery followed by EAP adjuvant chemotherapy. The patient remains alive and well at 8 years after surgery.     

Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer

Background

Accurate clinical staging of non-small cell lung cancer (NSCLC) is essential for developing an optimal treatment strategy. This study aimed to determine the predictive risk factors for lymph node metastasis, including both N1 and N2 metastases, in clinical T1aN0 NSCLC patients.

Methods

We retrospectively evaluated clinical T1aN0M0 NSCLC patients who showed no radiologic evidence of lymph node metastasis, and who had undergone surgical pulmonary resection with systematic mediastinal node dissection or sampling at the First Affiliated Hospital of Zhejiang University between January 2011 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for node metastasis.

Results

Pathologically positive lymph nodes were found in 16.2% (51/315) of the patients. Positive N1 nodes were found in 12.4% (39/315) of the patients, and positive N2 nodes were identified in 13.0% (41/315) of the patients. Some 9.2% (29/315) of the patients had both positive N1 and N2 nodes, and 3.8% (12/315) of the patients had nodal skip metastasis. Variables of preoperative radiographic tumor size, non-upper lobe located tumors, high carcinoembryonic antigen (CEA) levels and micropapillary predominant adenocarcinoma (AC) were identified as predictors for positive N1 or N2 node multivariate analysis.

Conclusions

Pathologically positive lymph nodes were common in small size NSCLC patients with clinical negative lymph nodes. Therefore, preoperative staging should be performed more thoroughly to increase accuracy, especially for patients who have the larger size, non-upper lobe located, high CEA level or micropapillary predominant ACs.     

CT检查食管癌不同区域淋巴结转移规律分析

目的探讨CT检查食管癌不同区域淋巴结转移规律。方法回顾性分析118例行根治性切除术的食管癌病例,术前行下颈区、纵隔、上腹部CT扫描,观察测量不同区域淋巴结的大小及个数,判断转移情况,术后与病理诊断对照分析。结果全组淋巴结总转移率为38.1%,纵隔和上腹部的淋巴结转移率较高,分别为36.7%和41.6%。术前CT检查食管癌不同区域淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值分别为下颈区75.0%、84.5%、27.2%、96.9%,纵隔63.0%、90.1%、65.3%、92.1%,上腹部70.0%、97.2%、70.0%、97.2%。结论术前CT检查下颈区、纵隔、上腹部能比较准确地反映食管癌淋巴结转移的分布规律,对下颈区淋巴结转移的灵敏度较高。