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1.
Background
We often observe that uptake of tracer is not detected in the primary cancer focus in patients with histologically proven papillary thyroid carcinoma (PTC) on preoperative 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT). Therefore, we analyzed the clinical and pathologic variables affecting false-negative findings in primary tumors on preoperative 18F-FDG PET/CT.Methods
We retrospectively reviewed the medical records of 115 consecutive patients who underwent 18F-FDG PET/CT for initial evaluation and were diagnosed with PTC by postoperative permanent biopsy. The clinical and pathologic characteristics that influence the 18F-FDG PET/CT findings in these patients were analyzed with respect to the following variables: age, gender, tumor size, multifocality of the primary tumor, perithyroidal invasion, lymphovascular or capsular invasion, and central lymph node metastasis-based final pathology.Results
Twenty-six (22.6%) patients had false-negative 18F-FDG PET/CT findings. In patients with negative 18F-FDG PET/CT findings, tumor size, and perithyroidal and lymphovascular invasion were significantly less than in patients with positive 18F-FDG PET/CT findings. Tumors >1 cm in size were correlated with 18F-FDG PET/CT positivity. On multivariate analysis, perithyroidal invasion (P = 0.026, odds ratio = 7.714) and lymphovascular invasion (P = 0.036, odds ratio = 3.500) were independent factors for 18F-FDG PET/CT positivity. However, there were no significant differences between 18F-FDG PET/CT positivity and age, gender, capsular invasion, and central lymph node metastasis based on final pathology.Conclusions
Tumor size and perithyroidal and lymphovascular invasion of papillary carcinoma can influence 18F-FDG PET/CT findings. Absence of perithyroidal and lymphovascular invasion were independent variables for false-negative findings on initial 18F-FDG PET/CT in patients with PTC. 相似文献2.
Makoto Sohda Hiroyuki Kato Shigemasa Suzuki Naritaka Tanaka Akihiko Sano Makoto Sakai Takanori Inose Masanobu Nakajima Tatsuya Miyazaki Minoru Fukuchi Noboru Oriuchi Keigo Endo Hiroyuki Kuwano 《Annals of surgical oncology》2010,17(12):3181-3186
Background
The role and potential usefulness of positron emission tomography (PET) scanning in certain tumors has been widely investigated in recent years. 18F-FAMT (L-[3-18F]-α-methyltyrosine) is an amino acid tracer for PET. This study investigated whether PET/CT with 18F-FAMT provides additional information for preoperative diagnostic workup of esophageal squamous cell carcinoma compared with that obtained by 18F-FDG (fluorodeoxyglucose) PET or CT.Methods
PET/CT studies with 18F-FAMT and 18F-FDG were performed as a part of the preoperative workup in 21 patients with histologically confirmed esophageal squamous cell carcinoma.Results
For the detection of primary esophageal cancer, 18F-FAMT-PET exhibited a sensitivity of 76.2%, whereas the sensitivity for 18F-FDG-PET was 90.5% (P = 0.214). 18F-FAMT uptake in primary tumors showed significant correlation with depth of invasion (P = 0.005), lymph node metastasis (P = 0.045), stage (P = 0.031), and lymphatic invasion (P = 0.029). In the evaluation of individual lymph node groups, 18F-FAMT-PET exhibited 18.2% sensitivity, 100% specificity, 71.9% accuracy, 100% positive predictive value, and 70.0% negative predictive value, compared with 24.2%, 93.7%, 69.8%, 66.6%, and 70.2%, respectively, for 18F FDG-PET. CT exhibited 39.4% sensitivity, 85.7% specificity, 69.8% accuracy, 59.1% positive predictive value, and 73.0% negative predictive value. The specificity of 18F-FAMT-PET is significantly higher than that of 18F-FDG-PET (P = 0.042) and CT (P = 0.002). 18F-FAMT-PET did not have any false-positive findings compared to those with 18F-FDG-PET.Conclusions
Our findings suggest that the addition of 18F-FAMT-PET to 18F-FDG-PET and CT would permit more precise staging of esophageal cancer. 相似文献3.
L. Tessonnier C. Ansquer C. Bournaud F. Sebag E. Mirallié J. C. Lifante F. F. Palazzo I. Morange D. Drui C. de la Foucardère J. Mancini D. Taïeb 《World journal of surgery》2013,37(1):107-112
Background
Adrenocortical carcinoma (ACC) is a rare cancer for which little level evidence exists to guide management. 18F-FDG PET (18F-fluorodeoxyglucose positron emission tomography) is an increasingly used diagnostic tool in patients with suspicious or indeterminate adrenal tumors. In some other solid tumors, 18F-FDG PET may offer prognostic information that can guide optimal patient treatment. The aim of the present study was to evaluate whether preoperative 18F-FDG PET based on SUVs assessments has a prognostic value in ACC patients.Methods
A retrospective analysis was performed in patients who underwent 18F-FDG PET/CT for the evaluation of ACC. Inclusion criteria were an unequivocal diagnosis of ACC; all data from primary diagnosis available; 18F-FDG PET/CT performed prior to surgery or other treatment of the primary tumor; a minimum of 6-months follow-up for surviving patients. All 18F-FDG PET/CT procedures were reinterpreted in a blind fashion.Results
Thirty-seven patients (23 without metastasis [M0], 14 with metastasis [M1]) fulfilled the study criteria. Median uptake values were tumor standardized uptake values (SUV)max = 11 (range: 3–56) and a tumor/liver SUVmax ratio = 4.2 (range: 1.3–15). Median follow-up was 20 months. Although classic risk factors (tumoral stage, Weiss score) were associated with poor outcome, there was no correlation between primary tumor FDG uptake with overall survival (OS) and disease free survival (DFS) in M0 patients and with overall survival in M1 patients. 18F-FDG uptake correlated inconsistently with sinister histological features, such as atypical mitoses or necrosis.Conclusions
At initial staging, primary tumor FDG uptake in ACC patients does not correlate with OS and DFS at 2 years. Patient prognosis and treatment strategy should not be based on uptake values. 相似文献4.
Bas B. Koolen MD Renato A. Valdés Olmos MD PhD Jelle Wesseling MD PhD Wouter V. Vogel MD PhD Andrew D. Vincent PhD Kenneth G. A. Gilhuijs PhD Sjoerd Rodenhuis MD PhD Emiel J. Th. Rutgers MD PhD Marie-Jeanne T. F. D. Vrancken Peeters MD PhD 《Annals of surgical oncology》2013,20(7):2227-2235
Background
If all initially node-positive patients undergo axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NAC), overtreatment may occur in patients with complete response. Positron emission tomography–computed tomography (PET/CT) during NAC may predict axillary response and select patients appropriate for less invasive treatment after NAC. We evaluated the value of sequential 18F fluorodeoxyglucose (FDG) PET/CTs during NAC for axillary response monitoring in stage II–III breast cancer.Methods
A total of 219 PET/CTs were performed in 80 patients with cytology-proven, node-positive disease at baseline (PET/CT1, n = 80) and twice during NAC (PET/CT2 n = 62, PET/CT3, n = 77). The relative changes in maximum standardized uptake value (SUVmax) of axillary nodes were examined for their ability to assess pathological response. All patients underwent ALND after chemotherapy, and complete axillary response (pCR), defined as absence of isolated tumor cells and of micro- and macrometastases, served as the reference standard.Results
A total of 32 (40 %) patients experienced axillary pCR. The relative decrease in SUVmax was significantly higher in patients with pCR than in those without, both on PET/CT2 (p < 0.001) and PET/CT3 (p = 0.025). The area under the receiver operating characteristic curve values for PET/CT2 and PET/CT3 were 0.80 (95 % confidence interval 0.68–0.92) and 0.65 (95 % confidence interval 0.52–0.79), respectively. A relative decrease of ≥60 % on PET/CT2 had an excellent specificity (35 of 37, 95 %), a high positive predictive value (12 of 14, 86 %), and a sensitivity of 48 %—that is, it accurately identified histologic pCR in 12 of 25 patients with disease that responded to therapy.Conclusions
18F-FDG PET/CT early during NAC is useful for axillary response monitoring in cytology-proven node-positive breast cancer because it identifies pathological response, thus permitting ALND to be spared. 相似文献5.
Christina Pfannenberg MD Ingmar Königsrainer MD Philip Aschoff MD Mehmet Ö. Öksüz MD Derek Zieker MD Stefan Beckert MD Stephan Symons Kay Nieselt PhD Jörg Glatzle MD Claus V. Weyhern MD Björn L. Brücher MD Claus D. Claussen MD Alfred Königsrainer MD 《Annals of surgical oncology》2009,16(5):1295-1303
Background
Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significantly longer survival in patients with peritoneal carcinomatosis (PC). So far, no morphological imaging method has proven to accurately assess the intra-abdominal tumor spread. This study was designed to predict tumor load in patients with PC using dual-modality 18FDG-PET/CT and to compare the results with those of PET and CT alone by correlating imaging findings with intraoperative staging.Methods
Twenty-two patients with PC from gastrointestinal (n = 13), ovarian cancer (n = 8), and mesothelioma (n = 1) underwent contrast-enhanced 18FDG-PET/CT before surgery and HIPEC. In a retrospective analysis PET, CT, and fused PET/CT were separately and blindly reviewed for the extent of peritoneal involvement using the Peritoneal Cancer Index (PCI). Imaging results were correlated with the intraoperative PCI using Pearson’s correlation coefficient and linear regression analysis.Results
There was a strong correlation between the PCI obtained with PET/CT and the surgical PCI with respect to the total score (r = 0.951) as well as in the regional analysis (small bowel, r = 0.838; other, r = 0.703). The correlation was slightly lower for CT alone (total score, r = 0.919; small bowel, r = 0.754; other, r = 0.666) and significantly lower (p = 0.002) for PET alone (total score, r = 0.793; small bowel, r = 0.553, other, 0.507).Conclusions
Contrast-enhanced CT is superior compared with PET alone to predict the extent of PC. In our patient group, the combination of both modalities (contrast enhanced PET/CT) yielded the best results and proved to be a useful tool for selecting candidates for peritonectomy and HIPEC. 相似文献6.
Lawrence F. Lau MBBS David S. Williams MBBS PhD FRCPA Sze Ting Lee MBBS FRACP Andrew M. Scott MD FRACP Christopher Christophi MD FRACS Vijayaragavan Muralidharan MBBS PhD FRACS 《Annals of surgical oncology》2014,21(7):2420-2428
Background
Biological characteristics of colorectal cancer liver metastases (CRCLM) are increasingly recognized as major determinants of patient outcome. The purpose of this study was to evaluate the prognostic value of metabolic response to preoperative chemotherapy as quantified by 18F-FDG positron emission tomography (PET) for patients undergoing liver resection of CRCLM.Methods
All patients (n = 80) who had staging PET before liver resection for CRCLM at Austin Health in Melbourne between 2004 and 2011 were included. Thirty-seven patients had PET and CT imaging before and after preoperative chemotherapy. Semiquantitative PET parameters—maximum standardized uptake variable (SUVmax), metabolic tumour volume (MTV), and total glycolytic volume (TGV)—were derived. Metabolic response was determined by the proportional change in PET parameters (?SUVmax, ?MTV, ?TGV). Prognostic scores, CT RECIST response, and tumour regression grading (TRG) were also assessed. Correlation to recurrence-free (RFS) and overall survival (OS) was assessed using Kaplan–Meier survival and multivariate analysis.Results
Semiquantitative parameters on staging PET before chemotherapy were not predictive of prognosis, whereas all parameters after chemotherapy were prognostic for RFS and OS. Only ?SUVmax was predictive of RFS and OS on multivariate analysis. Patients with metabolically responsive tumours had an OS of 86 % at 3 years vs. 38 % with nonresponsive or progressive tumours (p = 0.003). RECIST and TRG did not predict outcome.Conclusions
Tumour metabolic response to preoperative chemotherapy as quantified by PET is predictive of prognosis in patients undergoing resection of CRCLM. Assessing metabolic response uniquely characterizes tumour biology, which may allow future optimization of patient and treatment selection. 相似文献7.
Tomohiro Maniwa Masahiro Endo Mitsuhiro Isaka Kazuo Nakagawa Yasuhisa Ohde Takehiro Okumura Haruhiko Kondo 《Surgery today》2014,44(3):494-498
Purpose
Interstitial lung disease (ILD) has been associated with primary lung cancer and an increased risk of postoperative acute exacerbation (AE). The effectiveness of 2-[18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET) for staging lung cancer is well established. This study investigates the association of FDG uptake on PET in patients with AE of ILD.Methods
The subjects of this retrospective study were 1309 patients with lung cancer, who underwent pulmonary resection at Shizuoka Cancer Center between September, 2002 and January, 2011. ILD was diagnosed with chest computed tomography in 95 patients, 81 of whom underwent 18F-FDG PET before surgery. Six patients suffered from AE after surgery (AE group), while the remaining 75 (non-AE group) did not. We investigated the clinico-pathological findings and the results of FDG uptake on PET using the value of the I/M ratio, which is the ratio of the peak of standardized uptake value (SUV) of the ILD area to the mean SUV of the mediastinum.Results
There was no significant difference in clinico-pathological findings, but a significance difference in the I/M ratio (P = 0.0102).Conclusion
The FDG uptake in PET may be a predictive factor for AE of ILD in patients who have undergone lung cancer surgery. 相似文献8.
Hiroyuki Yamada Masao Hosokawa Kazuo Itoh Toshinao Takenouchi Yoshihiro Kinoshita Tomohiro Kikkawa Keita Sakashita Shion Uemura Yasunori Nishida Takaya Kusumi Shigeyuki Sasaki 《Surgery today》2014,44(7):1258-1265
Purpose
This study investigated the diagnostic accuracy of hybrid positron-emission tomography/computed tomography (PET/CT) for lymph node (LN) metastasis of esophageal cancer. We also investigated the correlation between the size of metastatic nests and the detection by PET/CT.Methods
Two hundred and fifty-eight patients with esophageal squamous cell carcinoma who underwent esophagectomy with two- or three-field radical lymphadenectomy were analyzed retrospectively. We compared the diagnosis of preoperative PET/CT to the postoperative histopathological examination by each anatomical field (n = 1,231) in all 258 patients. The metastatic LNs resected from PET/CT positive fields were classified as belonging to the PET/CT-N-positive group (n = 229) and those from negative fields as belonging to the PET/CT-N-negative group (n = 352). The cross-sectional areas of metastatic nests were measured in each metastatic LN.Results
Of the 1,231 fields, 275 (22 %) were positive for metastasis, including 581 LNs from 408 regional LN stations. The sensitivity and specificity of PET/CT examined by each anatomical field were 25.8 and 97.8 %, respectively. The median area of metastatic nests was 17.7 mm2 in the PET/CT-N-positive group, and 7.7 mm2 in the PET/CT-N-negative group (p < 0.001).Conclusions
A significant correlation was suggested between the nest size and detection by PET/CT. Because of its low sensitivity, PET/CT alone is insufficient to determine the surgical procedures, especially when considering reduction surgery. 相似文献9.
Jun-ichi Nitadori MD PhD Adam J. Bograd MD Eduardo A. Morales MS Nabil P. Rizk MD FACS Mark P. S. Dunphy DO Camelia S. Sima MD MS Valerie W. Rusch MD FACS Prasad S. Adusumilli MD FACS FCCP 《Annals of surgical oncology》2013,20(13):4282-4288
Purpose
Limited resection is an increasingly utilized option for treatment of clinical stage IA lung adenocarcinoma (ADC) ≤2 cm (T1aN0M0), yet there are no validated predictive factors for postoperative recurrence. We investigated the prognostic value of preoperative consolidation/tumor (C/T) ratio [on computed tomography (CT) scan] and maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose-positron emission tomography (PET) scan.Methods
We retrospectively reviewed 962 consecutive patients who underwent limited resection for lung cancer at Memorial Sloan-Kettering between 2000 and 2008. Patients with available CT and PET scans were included in the analysis. C/T ratio of 25 % (in accordance with the Japan Clinical Oncology Group 0201) and SUVmax of 2.2 (cohort median) were used as cutoffs. Cumulative incidence of recurrence (CIR) was assessed.Results
A total of 181 patients met the study inclusion criteria. Patients with a low C/T ratio (n = 15) had a significantly lower 5-year recurrence rate compared with patients with a high C/T ratio (n = 166) (5-year CIR, 0 vs. 33 %; p = 0.015), as did patients with low SUVmax (n = 86) compared with patients with high SUVmax (n = 95; 5-year CIR, 18 vs. 40 %; p = 0.002). Furthermore, within the high C/T ratio group, SUVmax further stratified risk of recurrence [5-year CIR, 22 % (low) vs. 40 % (high); p = 0.018].Conclusions
With the expected increase in diagnoses of small lung ADC as a result of more widespread use of CT screening, C/T ratio and SUVmax are widely available markers that can be used to stratify the risk of recurrence among cT1aN0M0 patients after limited resection. 相似文献10.
Kyohei Ariake Fuyuhiko Motoi Hideo Shimomura Masamichi Mizuma Shimpei Maeda Chiaki Terao Yasuko Tatewaki Hideo Ohtsuka Koji Fukase Kunihiro Masuda Hiroki Hayashi Tatsuyuki Takadate Takeshi Naitoh Yasuyuki Taki Michiaki Unno 《Journal of gastrointestinal surgery》2018,22(2):279-287
Background
We aimed to determine whether treatment should be stratified according to 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) maximum standardized uptake values (SUVmax) in pancreatic ductal adenocarcinoma.Methods
Patients who underwent preoperative 18F-FDG PET/CT between 2006 and 2014 (n = 138) were stratified into high (≥ 4.85) and low (< 4.85) PET groups. The clinicopathological characteristics and prognostic outcomes were analyzed retrospectively.Results
The primary tumor SUVmax was positively correlated with preoperative CA19-9 levels (P < 0.001). The high PET group failed to achieve postoperative CA19-9 normalization (P = 0.014). Disease-specific (P < 0.001), recurrence-free (P < 0.001), liver recurrence-free (P < 0.001), and peritoneal recurrence-free (P = 0.020) survivals were significantly shorter in the high PET group. The primary tumor SUVmax was an independent predictive risk factor for liver metastasis (hazard ratio 3.46, 95% confidence interval 1.61–7.87; P = 0.001) and peritoneal recurrence (hazard ratio 3.36, 95% confidence interval 1.18–10.89; P = 0.023).Conclusions
Surgical resection failed to achieve CA19-9 normalization in the high PET group and distant recurrence was frequent. This suggests the potential for residual cancer at distant sites, even after curative resection. Stronger preoperative systemic chemotherapy is preferred for the high PET group patients.11.
Chun-Ta Liao MD Chien-Yu Lin PhD Kang-Hsing Fan MD Chuen Hsueh MD Li-Yu Lee MD Hung-Ming Wang MD Shiang-Fu Huang PhD I-How Chen MD Chung-Jan Kang MD Shu-Hang Ng MD Chih-Hung Lin MD Yu-Chen Huang DDS Tzu-Chen Yen PhD 《Annals of surgical oncology》2013,20(1):257-266
Aim
To understand the frequency, clinical significance, and benefits of salvage therapy in oral cavity squamous cell carcinoma (OSCC) patients with regional nodal recurrence at unusual sites (prelaryngeal area, parotid area, and retropharyngeal area).Methods
We examined 178 patients with neck recurrence at levels I–V (usual group) and 26 patients outside levels I–V (unusual group). The 5-year survival rates served as the main outcome measure.Results
Of the 26 unusual group patients, the neck recurrence sites were as follows: 5 at the prelaryngeal area, 13 at the parotid area, and 8 at the retropharyngeal area. Multivariate analyses demonstrated that poor differentiation, pN2, extracapsular spread (ECS), tumor depth ≥10 mm, relapse time ≤10 months, local recurrence, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year disease-specific survival (DSS), whereas pN2, ECS, tumor depth ≥10 mm, relapse time ≤10 months, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year overall survival (OS). The 6-month and 18-month survival rates after the N-relapse date for the salvaged-usual group, the salvaged-unusual group, and the nonsalvaged patients were 73 %/46 %, 40 %/0 %, and 10 %/0 % (P < 0.0001), respectively [DSS: salvaged-unusual group (hazard ratio/95 % confidence interval), 2.060/1.058–4.008, P = 0.033; salvaged-usual group, 6.420/4.340–9.496, P < 0.001; OS: salvaged-unusual group, 2.100/1.080–4.081, P = 0.029; salvaged-usual group, 6.514/4.418–9.606, P < 0.001].Conclusions
Our findings demonstrate that OSCC patients with regional nodal recurrence at unusual sites had poor outcomes. 相似文献12.
Purpose
This study was designed to examine whether available preoperative clinical parameters, including B-type Raf kinase (BRAF) V600E mutation status, can identify patients at risk for central compartment lymph node metastasis (CLNM).Methods
Under an institutional review board-approved protocol, we conducted a single-center, retrospective review of all patients who had initial thyroidectomy for histologic papillary thyroid carcinoma (PTC) during 2010. The presence of CLNM was examined for correlation with available preoperative clinical parameters, including tumor size, gender, age, and BRAF mutation status.Results
Cervical lymph node resection and molecular testing on FNAB or histopathologic specimen was performed on a consecutive series of 156 study patients with histologic PTC. Overall, CLNM was diagnosed in 37 % and 46 % were BRAF-mutation-positive. BRAF positivity was the only clinical parameter associated with CLNM (BRAF, p = 0.002; tumor size ≥2 cm, p = 0.16; male gender, p = 0.1; age ≥45 years, p = 0.3) and remained an independent predictor of CLNM on multiple logistic regression analysis (odds ratio (OR) 3.2, p = 0.001). The PPV and NPV of BRAF positivity for CLNM was 50 and 74 %, respectively. When restricting the analysis to the subset of 38 patients who had molecular testing performed preoperatively on FNAB, the PPV and NPV of BRAF positivity for CLNM was 47 and 91 %, respectively, and BRAF positivity was still a significant predictor of CLNM on both univariate (OR 8.4, p = 0.01) and multivariate (OR 9.7, p = 0.02) analyses.Conclusions
Of the commonly used clinical parameters available preoperatively, the BRAF V600E mutation is the only independent predictor of CLNM in PTC and can be utilized to guide the extent of initial surgery. 相似文献13.
Yuji Miyamoto Toshimasa Ishii Jo Tashiro Takahiro Satoh Masayuki Watanabe Hideo Baba Shigeki Yamaguchi 《Surgery today》2014,44(7):1293-1299
Purpose
This study evaluated the feasibility and safety of laparoscopic colorectal surgery for cancer in obese patients based on the short-term outcomes.Methods
We conducted a retrospective analysis of 561 patients with colorectal cancer treated from April 2007 to October 2010. The surgical outcomes were compared between non-obese (BMI <25 kg/m2) and obese (BMI ≥25 kg/m2) patients.Results
All of the enrolled patients were classified as non-obese (n = 421) or obese (n = 140). The obese group had a significantly higher proportion of male patients (72.1 vs. 57.0 %; P = 0.002), a higher incidence of left colon cancer (49.3 vs. 36.8 %; P = 0.033), and more systematic comorbidities (P < 0.001) than did the non-obese group. The length of the surgery was significantly longer in obese than in non-obese patients (221 vs. 207 min; P = 0.025). There was no significant difference in the overall incidence of postoperative complications between the two groups; however, surgical wound infections were more common in obese patients (12.1 vs. 5.2 %; P = 0.005). Obesity was not a significant-independent risk factor for total postoperative complications (odds ratio 1.330; P = 0.289).Conclusion
Laparoscopic colorectal surgery is technically feasible and safe for obese patients and provides all the benefits of a minimally invasive approach. 相似文献14.
Masanori Tokunaga MD Norihiko Sugisawa MD Yutaka Tanizawa MD PhD Etsuro Bando MD PhD Taiichi Kawamura MD PhD Masanori Terashima MD PhD FACS 《Annals of surgical oncology》2013,20(5):1598-1603
Background
Multidetector-row computed tomography (MDCT) is widely used to predict pathological nodal status. However, an appropriate nodal size cutoff value to predict pathological nodal status has not been determined, and the impact of preoperative lymph node size on long-term outcomes is unclear.Methods
This study included 137 gastric cancer patients with nodal involvement who underwent R0 gastrectomy between September 2002 and December 2006. Lymph nodes with a short-axis diameter of 10 mm or more as measured by MDCT were regarded as metastasized. An appropriate cutoff value with a high positive predictive value (PPV) and high specificity also was identified, and the subsequent clinicopathological characteristics and long-term outcomes were investigated.Results
A cutoff value of 15 mm was found to be appropriate for grouping patients into large (≥15 mm) and small (<15 mm) lymph node metastasis (LLNM and SLNM) groups, with a high PPV (98.6 %) and specificity (99.8 %). There were no differences in clinicopathological characteristics between the groups except for pathological nodal status. In the LLNM group, the 5-year survival rate was 55 %, which was significantly lower than in the SLNM group (73.2 %; P = 0.008). After stratification by tumor depth, the same trend was observed in patients with pT3 disease (46.8 % vs. 72.7 %; P = 0.015) and those with pT4 disease (14.3 % vs. 64.8 %; P = 0.035).Conclusions
Gastric cancer patients with lymph nodes measuring 15 mm or more preoperatively have worse long-term outcomes. These patients would therefore be suitable candidates for future clinical trials investigating the efficacy of neoadjuvant chemotherapies. 相似文献15.
Makoto Yamasaki MD Hiroshi Miyata MD Yasuhiro Miyazaki MD Tsuyoshi Takahashi MD Yukinori Kurokawa MD Kiyokazu Nakajima MD Shuji Takiguchi MD Masaki Mori MD Yuichiro Doki MD 《Annals of surgical oncology》2014,21(9):2850-2856
Background
The 7th edition of the Union for International Cancer Control-TNM (UICC-TNM) classification for esophageal carcinoma made considerable modifications to the definition of N-staging by the number of involved lymph nodes and the regional node boundary. There were few validations of the regional boundary. We evaluated the nodal status of this classification for esophageal squamous cell carcinoma (ESCC).Methods
There were 665 patients reviewed who had ESCC and underwent esophagectomy between 1997 and 2012. We evaluated the impact of the location of lymph node metastasis on overall survival.Results
There were 414 patients (61.7 %) who had lymph node metastases. The overall 5-year survival rate was 54.7 %. There were no significant differences in survival among N2, N3, and M1 patients. Cox regression analysis revealed that common hepatic or splenic node involvements (P = 0.001), pT stage (P = 0.0002), and pN stage (P < 0.0001) were independent predictors of survival, but supraclavicular node involvement (P = 0.29) was not. We propose a modified nodal status that designates supraclavicular node as regional: m-N0 (5-year survival = 79 %; n = 251); m-N1 (5-year = 56 %; n = 212); m-N2 (5-year = 30 %; n = 114); m-N3 (5-year = 18 %; n = 52); m-M1 (5-year = 6.2 %; n = 36). This modified nodal staging predicts survival better than the current staging system.Conclusions
The modification of supraclavicular lymph node from nonregional to regional in the 7th UICC classification of ESCC may allow for better stratification of overall survival. 相似文献16.
Wisam Khoury Ravi P. Kiran Timothy Jessie Daniel Geisler Feza H. Remzi 《Surgical endoscopy》2010,24(6):1336-1340
Background
The feasibility and safety of laparoscopic colectomy (LC) for morbidly obese patients has not been reported previously. This study aimed to assess the clinical outcomes of patients with a body mass index (BMI) of 40 kg/m3 or more who undergo laparoscopic colorectal surgery.Methods
Prospectively accrued data for patients with a BMI of 40 kg/m3 or more (group A) who undergo LC were compared with those for patients with BMI lower than 30 kg/m3 (group B) matched for year of surgery, indication, operating surgeon, and type of procedure.Results
Each group had 36 patients. The group A patients were significantly younger (54 vs. 61 years; P = 0.04), had higher American Society of Anesthesiology (ASA) scores (P = 0.001), and had diabetes mellitus (P = 0.04). The indications for surgery and the operations performed were similar. The two groups had similar operating times (177.9 vs. 136.4 min; P = 0.12), estimated blood losses (222.3 vs. 157 ml; P = 0.1), median lengths of hospital stay (LOS) (4.5 vs. 4 days; P = 0.2), and returns of bowel function (4.2 vs. 3.9 days; P = 0.45). Group A had significantly longer incisions (6.9 vs. 5 cm; P = 0.02). Conversions (5 vs. 3 patients; P = 0.7), readmissions (12 vs. 6 patients; P = 0.46), reoperations (5 vs. 3 patients; P = 0.17), wound infections (7 vs. 2 patients; P = 0.14), anastomotic leaks (3 vs. 2 patients; P = 0.7), and abdominal abscesses (3 vs. 2 patients; P = 0.7) were more predominant in group A, although the differences did not reach statistical significance.Conclusions
Laparoscopic colectomy is feasible for morbidly obese patients and results in recovery of intestinal function and LOS equivalent to that for nonobese patients. As expected, morbidity and conversion rates are higher for morbidly obese patients undergoing LC than for nonobese patients. 相似文献17.
Background
The rising incidence of incidental thyroid carcinoma (ITC) detected during fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scanning poses a challenge to clinicians. The present study aims to critically evaluate the clinicopathological characteristics of ITC detected by FDG-PET/CT.Methods
Among the 557 patients managed at our institution, 40 (7.2%) patients were identified as having ITC. Of these, 22 patients had their tumor detected by FDG-PET/CT (PET group) and 11 by ultrasonography (USG group). Additional bedside ultrasonography ± fine-needle aspiration (FNA) was done in all patients at their clinic visit. The clinicopathological characteristics were compared between the PET and USG groups.Results
The PET group had significantly more patients with history of nonthyroidal malignancy (P < 0.001). Papillary carcinoma was the most common histological type in both groups. Despite having similar histological and prognostic features including tumor size, tumor multifocality, capsular invasion, extrathyroidal extension, and lymph node metastases, tumor bilaterality (or presence of contralateral tumor focus) was significantly more frequent in the PET than the USG group (P = 0.04). The tumors were also more advanced by the tumor–node–metastasis (TNM) staging system in the PET group (P = 0.021). None of the contralateral tumor foci were evident preoperatively. One patient in the USG group developed metastatic thyroid carcinoma in neck lymph nodes 28 months after thyroid resection.Conclusion
ITC by FDG-PET/CT had higher incidence of tumor bilaterality than those detected by ultrasonography. Total thyroidectomy should be considered for ITC detected by FDG-PET/CT even for tumor size <10 mm. 相似文献18.
Maxim Rybalov Anthonius J. Breeuwsma Anna M. Leliveld Jan Pruim Rudi A. Dierckx Igle J. de Jong 《World journal of urology》2013,31(2):319-323
Purpose
To evaluate the effect of total PSA (tPSA) and PSA kinetics on the detection rates of 11C-Choline PET in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) or external beam radiotherapy (EBRT).Methods
We included 185 patients with BCR after RP (PSA >0.2 ng/ml) or after EBRT (ASTRO definition). After injection of 400 MBq 11C-Choline i.v., a scan was made using the ECAT HR + PET camera with CT fusion images or Siemens mCT PET/CT. Biopsy-proven histology, confirmative imaging (CT or bone scan) and/or clinical follow-up (PSA) were used as composite reference. Statistical analysis was performed using PASW Statistics 18.Results
11C-Choline PET was positive in 124/185 cases (65 %) (in 22/61 (36 %) after RP, 102/124 (82 %) after EBRT). In 79 patients a local recurrence was identified, and 45 patients showed locoregional metastases on PET/CT. In 20 cases a proven false-negative PET scan was observed. Positive PET scans were confirmed by histology in 87/124 (70 %) cases, by confirmatory imaging in 34/124 (28 %) and by clinical follow-up after salvage treatment in 3 (2 %) cases. The ROC analysis to detect a recurrence showed significant difference in area under the curve (AUC) of tPSA 0.721(p < 0.001) and PSA velocity 0.730 (p < 0.001). PSA doubling time showed no significant difference with an AUC of 0.542 (p = 0.354). Detection rates are <50 % in tPSA <2 ng/ml and/or PSA velocity <1 ng/ml/year.Conclusions
Total serum PSA and PSA velocity have significant effect on the detection rates of 11C-Choline PET/CT in men with a BCR after RP or EBRT. 相似文献19.
D. L. Sanders D. H. Samarakoon S. W. Ganshirt C. S. Porter A. N. Kingsnorth 《Hernia》2009,13(5):499-503
Introduction
Mesh plug is an established and effective method for repair of inguinal hernia. The ProLoop plug® (Atrium) is a recently developed mesh plug with a novel configuration, which may offer advantages over the standard Prefix plug® (Bard) or the Lichtenstein repair. This two-centre double-blinded randomised control trial assessed the short- and medium-term outcomes, comparing the above three methods.Patients and methods
Consecutive patients over the age of 18 years with primary unilateral inguinal hernia were randomised to receive a Lichtenstein tension free mesh repair (LTFM), Perfix® plug (Bard) (PF) or ProLoop® plug (Atrium) (PL) repair. Follow-up was at 2 weeks, 6 months and 12 months. Endpoints were operative time, hospital stay, bodily pain scores, return to daily activity and complications.Results
A total of 295 consecutive patients were recruited to the study. Ninety-three patients were randomised to receive PL plug repairs, 101 PF plug repairs and 101 LTFM repairs. There was no significant difference among the three groups in terms of age, sex or BMI. There was no significant difference among the groups in terms of operative time (PL vs PF P = 0.92; PL vs LTFM P = 0.52), hospital stay (PL vs PF P = 0.74; PL vs LTFM P = 0.44), bodily pain scores (at 12 months PL vs PF P = 0.84, PL vs LTFM P = 0.85, PF vs LTFM P = 0.16), complication rates or return to daily activity.Conclusions
The ProLoop® plug (Atrium) is a safe and effective method of repairing primary inguinal hernias. Its novel lightweight configuration does not increase the risk of recurrence when compared to thicker mesh plugs, and it may offer benefit in terms of long-term patient comfort. The ProLoop® plug (Atrium) represents a new effective alternative to the established mesh repairs. 相似文献20.
So-Youn Jung MD Seok-Ki Kim MD PhD Byung-Ho Nam PhD Sun Young Min MD Seung Joo Lee MD Chansung Park MD Youngmee Kwon MD PhD Eun-A Kim MD PhD Kyoung Lan Ko MD PhD In Hae Park MD Keun Seok Lee MD PhD Kyung Hwan Shin MD PhD Seeyoun Lee MD PhD Seok Won Kim MD PhD Han-Sung Kang MD PhD Jungsil Ro MD 《Annals of surgical oncology》2010,17(1):247-253