转移淋巴结的数量和范围对食管癌预后的影响

目的探讨转移淋巴结枚数、组数及野数对食管癌患者预后的影响,为更加合理的淋巴结转移分级提供参考。方法回顾性分析2001年6月至2009年12月间在上海市胸科医院进行手术治疗的204例食管癌患者的临床资料,并按照2009年第七版国际食管癌TNM分期对所有患者进行重新分期。采用Log-rank检验和Cox比例风险模型来评估转...     

新辅助治疗对局部进展期食管癌淋巴结转移数目及范围的影响

食管癌术前新辅助放化疗可影响转移淋巴结的数目及转移淋巴结的分布。本研究旨在探讨新辅助放化疗如何改变局部进展期食管癌的淋巴结转移模式。     

淋巴结转移率较TNM分期是否能更好地预测结肠癌患者的预后？

目前,临床根据TNM分期来判断Ⅲ期结肠癌患者是否进行辅助化疗。临床N分期越高,患者预后越差。有研究显示,淋巴结转移率比TNM分期能更好地预测患者预后。为了验证研究结论的正确与否,Schiffmann L等人收集了在2000～2009年期间接受根治术的142例Ⅲ期结肠癌患者的信息,并根据淋巴结转移率分成两组——低淋巴结转移率组和高淋巴结转移率组,分别与临床N1和N2分期患者比较无病生存率和癌症相关生存率。     

近端胃癌手术时淋巴结清扫范围、数目及转移的研究

目的研究近端胃癌手术时淋巴结切除范围、数目、转移和预后的关系。方法 行D2或D3术式的近端胃癌标本，全数摘取淋巴结，比较全胃切除和近端胃切除的淋巴结切除数目并判断预后。结果 本组31例共取淋巴结1971枚，平均63枚／例。近端胃切除57枚／例，全胃切除71枚／例，左半胰切除64枚／例，保留左半胰63枚／例。新分期N1、N2、N35年生存率分别为36％、11％、0。结论 随着癌肿侵犯范围扩大，必须扩大淋巴结切除范围；保留左半胰不影响淋巴结切除数目；新的定量N分期在评价预后方面优于旧的定性N分期。     

食管癌淋巴结转移规律及预测模型研究进展

食管的淋巴管网丰富,引流范围广泛,涉及颈、胸和腹等处20余组淋巴结。淋巴结转移状态也是确定食管癌分期的重要指标,是判断患者预后的独立因子。手术依然是食管癌治疗最重要的方式之一。然而,目前关于食管癌淋巴结转移规律和食管癌淋巴结清扫范围依然缺乏统一的认识。选择性三野淋巴结清扫似乎更符合个性化医疗和精准医疗的时代潮流,但由于影像学诊断颈部淋巴结转移的灵敏性和特异性不足,选择性三野淋巴结清扫仍需高质量的临床证据验证。基于大数据的数学建模和影像组学已辅助用于疾病的临床诊断、治疗和预后的临床抉择,对其深入的研究及发展将有助于食管癌相关的诊断和治疗。     

微创食管癌切除术后淋巴结转移规律及预后分析

目的淋巴结转移是食管癌转移的主要方式,对食管癌患者预后有重要影响,本文探讨食管癌胸腹二区淋巴结的转移规律。 方法选取2010年1月至2016年10月于山东大学齐鲁医院经微创食管癌切除术(minimally invasive esophagectomy, MIE)治疗的食管癌患者613例,参照日本食管肿瘤研究会(JEOG)淋巴结分区标准清扫淋巴结,统计各组淋巴结的转移率。对2010年1月至2013年10月行MIE治疗的203例食管癌患者进行生存分析。另外410例患者由于术后时间较短,随访数据未列入统计。 结果胸上段食管癌较多发生上纵隔淋巴结转移,其左、右喉返神经旁淋巴结转移率分别高达35.9%、40.7%,均显著高于胸中段和胸下段食管癌;胸中段食管癌既向上发生上纵隔淋巴结转移,又向下发生腹腔淋巴结转移;胸下段食管癌主要向胃周淋巴结转移,其中胃左动脉旁淋巴结转移率最高。单因素分析结果显示,病变长度、肿瘤分化程度、肿瘤浸润深度、淋巴结转移程度是影响食管癌患者预后的相关因素(P< 0.05)。COX多因素回归分析结果显示,肿瘤低分化和淋巴结转移是影响食管癌患者预后不良的独立危险因素(P< 0.05)。 结论手术治疗食管癌应重点清扫双侧喉返神经旁淋巴结和胃左动脉旁淋巴结。     

影响T1～2期结直肠癌淋巴结转移和预后的因素分析

目的 探讨影响T1～2期结直肠癌淋巴结转移及预后的因素,为临床治疗提供参考.方法 回顾性分析上海第二军医大学附属长海医院1999年1月至2005年1月行结直肠癌根治手术并经病理证实为T1～2期的132例患者的临床资料.结果 肿瘤部位和肿瘤浸润深度是影响本组T1～2期结直肠癌患者淋巴结转移的独立危险因素（分别为P＜0.01和P＜0.05）;而患者性别、年龄、肿瘤大体类型、肿瘤组织学类型、肿瘤分化程度、CEA水平、肿瘤直径均与其淋巴结转移无关（均P＞0.05）.淋巴结转移和术后随访过程中远处脏器的转移是影响患者生存的独立危险因素（分别为P＜0.05和P＜0.01）.结论 影响T1～2期结直肠癌患者淋巴结转移的因素并不影响患者的生存,但淋巴结转移和远处脏器转移是影响预后的危险因素     

淋巴结转移特征在胃癌外科治疗中的意义

目的：探讨胃癌患者淋巴结转移特征及其在外科治疗中的临床意义。方法回顾性分析行手术治疗的460例胃癌患者的临床资料,就其淋巴结转移特征,按照肿瘤TNM分期、原发灶大小以及Borrmann大体分型分别对患者进行分组,比较组间淋巴结转移发生率的差异。结果460例患者中,320例检出淋巴结转移,淋巴结转移发生率69．57％（320／460）。淋巴结转移发生率与胃癌的TNM分期、原发灶大小以及Borrmann大体分型相关,TNM分期越晚、原发灶直径越大、Borrmann大体分型级别越高,则患者淋巴结转移发生率越高,组间差异有统计学意义（P＜0．05）。结论淋巴结转移发生率与胃癌患者的肿瘤TNM分期、原发灶大小以及Borrmann大体分型相关。     

影响T1～2期结直肠癌淋巴结转移和预后的因素分析

Objective To investigate factors associated with lymph node metastasis and prognosis in patients with T1-2 colorectal cancer. Methods Patients with pT1-2 colorectal cancer between January 1999 to January 2005 were included. Chi-square test and multivariable logistic analysis were performed to evaluate risk factors associated with lymph node metastasis. Survival outcomes were analyzed using Kaplan-Meier and Cox regression model. Results Tumor location and depth of invasion were independent risk factors for lymph node metastasis (P＜0.01 and P＜0.05). Gender, age, tumorgross pattern, tumor differentiation, carcinoembryonic antigen level, and tumor diameter were notassociated with lymph node metastasis. Lymph node metastasis and distant metastasis on postoperative follow-up were independent risk factors for survival (P＜0.05 and P＜0.01). Conclusion Factors associated with lymph node metastasis in pT1-2 colorectal cancer do not affect the survival. However,lymph node metastasis and distant metastasis are predictive for survival.     

淋巴结转移在胃癌预后中的评价

淋巴结转移为胃癌最常见的转移方式,是影响胃癌预后的重要原因之一,基于淋巴结转移数目和解剖位置的胃癌淋巴结转移分期(N分期)是最常见的预后评估和诊断分期方式,围绕N分期的研究至今仍在不断进行优化完善。许多特殊类型的淋巴结转移也逐渐被认识,如癌结节、淋巴结微转移、孤立肿瘤细胞及跳跃性转移。此文从淋巴结转移的机制、淋巴结转移分期演变、特殊淋巴结转移类型进行综合探讨淋巴结转移如何影响胃癌预后的评估。     

胸段食管癌颈部及上纵隔淋巴结转移

探讨胸段食管癌颈部及上纵隔淋结转移规律。方法采用颈,胸,腹三切口施行胸段食管癌手术６１６例,同时施行三区域淋巴洁清扫。结果：中及上纵隔淋巴结转移率和转移度分别为５７．１％和２１．５％。结论胸段食管癌必须重颈部及上纵隔淋巴结清扫。     

Prognosis of Lymph Node Metastasis in Soft Tissue Sarcoma

Background: We defined the tumor characteristics and prognosis of patients with regional lymph node metastasis (RLNM) from soft tissue sarcoma.Methods: All patients with RLNM from soft tissue sarcoma were identified from the Royal Marsden Hospital Sarcoma Unit prospective database from January 1990.Results: A total of 73 (3.4%) of 2127 patients had RLNM. Fifty-seven patients (78.1%) had RLNM as the first site of spread, and 16 patients (21.9%) presented with RLNM and distant metastasis synchronously. The most common histologies were rhabdomyosarcoma, epithelioid sarcoma, and angiosarcoma. There were 9 T1 and 36 T2 tumors, and tumor size was not available in 28 patients. There were 6 grade 1, 16 grade 2, and 51 grade 3 tumors. Forty-two patients presented with RLNM along with the primary tumor. Of the remaining patients, the median time to development of RLNM from diagnosis of the primary tumor was 13.5 months (95% confidence interval [CI], 1–100 months). The 1-year survival for patients with isolated RLNM was 77.49% (95% CI, 62.99%–86.88%), compared with 36.27% (95% CI, 13.32%–60.04%) for patients who presented with RLNM and distant metastasis (P = .005). The 1-year survival for metachronous and synchronous RLNM was 94.44% (95% CI, 66.64%–99.20%) and 67.54% (95% CI, 47.89%–81.12%), respectively (P = .05).Conclusions: Lymph node metastasis is rare. Patients who present with isolated RLNM have an improved survival compared with patients who present with regional and distant metastasis at diagnosis. Synchronous RLNM with the primary tumor have a poorer outcome than metachronous RLNM in the absence of distant metastasis.     

Postoperative Gastrointestinal Dysfunction after 2-field Versus 3-field Lymph Node Dissection in Patients with Esophageal Cancer

Purpose Using an instrument we developed to assess postoperative dysfunction objectively (Surg Today 2005;35:535–42), we compared postoperative dysfunction after 2 - field versus 3 - field lymph node dissection retrospectively, in patents undergoing esophageal cancer surgery. Methods Subjects were selected randomly from among patients who had undergone radical surgery for squamous cell carcinoma of the thoracic esophagus followed by reconstruction with a gastric tube and a cervical anastomosis. Patients rated 32 items related to postoperative dysfunction according to a 5-grade scale. Postoperative gastrointestinal dysfunction was evaluated on the basis of the total score and the scores for seven symptom categories: decreased physical activity, symptoms of reflux, dumping-like syndrome, nausea and vomiting, passage dysfunction, pain, and diarrhea or soft feces. Results We studied 42 patients, 22 of whom underwent 2-field lymph node dissection and 20 of whom underwent 3-field dissection. The total gastrointestinal dysfunction score was significantly higher in the 3-field group than in the 2-field group (78.4 ± 14.1 points vs 67.9 ± 16.9 points, P = 0.038). When we analyzed the data according to the symptom categories, the 3-field group had higher scores for decreased physical activity, symptoms of reflux, dumping-like syndrome, nausea and vomiting, and passage dysfunction. Conclusion Three-field lymph node dissection was associated with greater postoperative gastrointestinal dysfunction than 2-field lymph node dissection. Thus, the preoperative identification of those patients with esophageal cancer who are most likely to benefit from concurrent cervical lymph node dissection is essential.     

Prognostic Significance of Level and Number of Lymph Node Metastases in Patients with Gastric Cancer

BACKGROUND: To present data that provide some insight into the appropriateness of a nodal grouping category and its relation to survival in patients with gastric cancer. METHODS: We reviewed data of 777 patients with advanced gastric cancer who had undergone curative gastrectomy to investigate the prognostic significance of level and number of lymph node metastases. RESULTS: The prognosis of patients with gastric cancer was well correlated with the level and number of lymph node metastases. Multivariate analysis indicated that the level and number of lymph node metastases were independent prognostic indicators. Moreover, the number of lymph node metastases was an independent prognostic factor in N1, N2, and N3 patients. The most statistically significant difference in disease-specific survival was observed at a threshold of 11 lymph node metastases, yielding a chi2 value of 42.88, a hazard ratio of 2.523, at a 95% confidence interval of 1.913, 3.329 (P < .0001) by Cox proportional hazard model. On the basis of this result, patients were divided into two groups as follows: marked lymph node metastasis group (number of positive nodes > or =11) and slight lymph node metastasis group (number of positive nodes < or =10). The prognosis of patients with marked lymph node metastasis was statistically significantly worse than that with slight lymph node metastasis in N1, N2, and N3 patients. CONCLUSIONS: Both level and number were indispensable for evaluating lymph node metastasis. Therefore, addition of the number of positive nodes to the N category defined by the Japanese Classification of Gastric Carcinoma may be a useful strategy in the N staging classification in gastric cancer.     

Extranodal Extension Is a Powerful Prognostic Factor in Bladder Cancer Patients with Lymph Node Metastasis

Background

Lymph node metastasis (LNM) is the most powerful pathologic predictor of disease recurrence after radical cystectomy (RC). However, the outcomes of patients with LNM are highly variable.

Objective

To assess the prognostic value of extranodal extension (ENE) and other lymph node (LN) parameters.

Design, setting, and participants

A retrospective analysis of 748 patients with urothelial carcinoma of the bladder and LNM treated with RC and lymphadenectomy without neoadjuvant therapy at 10 European and North American centers (median follow-up: 27 mo).

Intervention

All subjects underwent RC and bilateral pelvic lymphadenectomy.

Outcome measurements and statistical analysis

Each LNM was microscopically evaluated for the presence of ENE. The number of LNs removed, number of positive LNs, and LN density were recorded and calculated. Univariable and multivariable analyses addressed time to disease recurrence and cancer-specific mortality after RC.

Results and limitations

A total of 375 patients (50.1%) had ENE. The median number of LNs removed, number of positive LNs, and LN density were 15, 2, and 15, respectively. The rate of ENE increased with advancing pT stage (p < 0.001). In multivariable Cox regression analyses that adjusted for the effects of established clinicopathologic features and LN parameters, ENE was associated with disease recurrence (hazard ratio [HR]: 1.89; 95% confidence interval [CI], 1.55–2.31; p < 0.001) and cancer-specific mortality (HR: 1.90; 95% CI, 1.52–2.37; p < 0.001). The addition of ENE to a multivariable model that included pT stage, tumor grade, age, gender, lymphovascular invasion, surgical margin status, LN density, number of LNs removed, number of positive LNs, and adjuvant chemotherapy improved predictive accuracy for disease recurrence and cancer-specific mortality from 70.3% to 77.8% (p < 0.001) and from 71.8% to 77.8% (p = 0.007), respectively. The main limitation of the study is its retrospective nature.

Conclusions

ENE is an independent predictor of both cancer recurrence and cancer-specific mortality in RC patients with LNM. Knowledge of ENE status could help with patient counseling, clinical decision making regarding inclusion in clinical trials of adjuvant therapy, and tailored follow-up scheduling after RC.     

早期胃癌淋巴结转移潜在危险因素分析

目的:探讨影响早期胃癌淋巴结转移的潜在危险因素,指导胃癌淋巴结清扫术(D1或D2)的合理应用。方法:回顾性分析1995年3月—2010年6月经手术治疗的336例早期胃癌患者的临床病理资料,对影响早期胃癌淋巴结转移的潜在危险因素进行单因素及多因素分析。结果:早期胃癌淋巴结转移与性别(P=0.010)、年龄(P=0.013)、肿瘤部位(P=0.042)、有无合并溃疡(P=0.001)、浸润深度(P<0.0001)、有无脉管癌栓(P<0.0001)有关,合并有溃疡(P=0.012)、浸润至黏膜下层(P=0.008)及有脉管癌栓(P=0.001)是淋巴结转移的独立性危险因素;黏膜内癌淋巴结转移与肿瘤部位(P=0.007)及大小(P=0.010)有关,肿瘤直径>20mm(P=0.041)是黏膜内癌淋巴结转移的独立性危险因素。结论:合并有溃疡、浸润至黏膜下层及有脉管癌栓的早期胃癌患者进行手术时,建议行淋巴结清扫(D2)术;肿瘤直径>20mm黏膜内癌也要考虑行淋巴结清扫(D2)术。     

Surgical Outcomes in Esophageal Cancer Patients with Tumor Recurrence After Curative Esophagectomy

This study aimed to identify predictive factors and to evaluate appropriate treatments for recurrence of esophageal cancer after curative esophagectomy. About 166 consecutive patients, who underwent curative esophagectomy, were enrolled between April 1994 and March 2003. Recurrence was classified as loco-regional or distant. Logistic regression analysis was used to identify predictive factors for recurrence. Prognostic factors were evaluated by Log-rank test and Cox proportional hazard regression analysis. The disease-specific 5-year survival was 56.8%. Recurrence was observed in 72 patients (43.4%), with 64 of these occurring within 3 years. The number of metastatic lymph nodes and lymphatic invasion independently predicted recurrence. There were significant differences in time to recurrence and survival time between loco-regional, distant recurrence, and combined recurrence. The 5-year survival time in patients with recurrence was 11.9%, and median survival time was 24 months. There was also a significant difference in survival after recurrence between treatment methods (no treatment vs chemo-radiotherapy, p = 0.0063; chemotherapy, p = 0.0247; and radiotherapy, p < 0.0001). Meticulous, long-term follow-up is particularly necessary in patients with four or more metastatic lymph nodes to achieve early detection of recurrence. Randomized controlled trials should be used to develop effective modalities for each recurrence pattern to improve therapeutic outcomes.     

Risk Factors for Lymph Node Metastasis in Undifferentiated Early Gastric Cancer

Background Endoscopic surgery has not been accepted as a curative treatment for intramucosal undifferentiated early gastric cancer (EGC). The purpose of this study was to evaluate the predictive factors of lymph node metastasis and explore the possibility of using endoscopic surgery for undifferentiated EGC. Methods We retrospectively analyzed 646 patients with undifferentiated EGC who had undergone gastrectomy with D2 lymphadenectomy from January 2000 to March 2005. We used univariate and multivariate analysis to identify clinicopathological features that were predictive factors for lymph node metastasis. Results The incidence of lymph node metastasis was 4.2% in intramucosal and 15.9% in submucosal undifferentiated EGC. Multivariate analysis revealed that submucosal invasion, larger tumor size (greater than 2 cm), and presence of lymphovascular invasion (LVI), were significantly associated with lymph node metastasis in patients with undifferentiated EGC. Tumor size and LVI were independent risk factors for lymph node metastasis in cases of intramucosal EGC. Lymph node metastasis was found in only one patient (0.5%) who had neither of the two risk factors for intramucosal EGC. Conclusion Complete endoscopic resection may be acceptable as a curative treatment for intramucosal undifferentiated EGC when the tumor size is less than or equal to 2 cm, and when LVI is absent in the postoperative histological examination. Radical gastrectomy should be recommended if LVI or unexpected submucosal invasion is present.     

Solitary Lymph Node Metastasis in Gastric Cancer

The feasibility and diagnostic reliability of sentinel node (SN) biopsy for gastric cancer are still controversial. We studied the clinicopathological features and localization of solitary lymph node metastasis (SLM) in gastric cancer to provide useful information for use of the SN concept in gastric cancer. From 2000 to 2004, 3,267 patients with gastric cancer underwent D2 radical gastrectomy. The clinicopathological features of 195 patients with histologically proven SLM and the distribution of metastasized nodes were assessed. The incidence of SLM was 6.0% in all cases. Compared with the node-negative patients, significant differences were observed in age, tumor size, depth of invasion, and surgical type. The cumulative 5-year survival rate of patients with SLM was 80.5%, which was significantly lower than 90.2% for node-negative patients (P < 0.001). Of patients with SLM, 82.6% had it in the perigastric node area (N1), and the other 17.4% patients had skip metastasis in the N2-N3 nodes. Perigastric nodes were the most common first sites of drainage from the tumor, making them the main targets of the operative SN mapping procedure. Due to the higher than expected incidence of skip metastasis in gastric cancer, D2 lymphadenectomy should be performed until the reliability of SN navigation surgery is validated in multicenter prospective clinical trials.     

Lymph Node Size and Metastatic Infiltration in Colon Cancer

Background: Detection of metastatic lymph nodes in colon cancer is essential for determining stage and adjuvant treatment modalities. Lymph node size has been used as one possible criterion for nodal metastasis. Although enlarged regional lymph nodes are generally interpreted as metastases, few data are available that correlate lymph node size with metastatic infiltration in colon cancer.Methods: In a prospective morphometric study, the regional lymph nodes from 30 colon specimens from consecutive patients with primary colon cancer were analyzed. The lymph nodes were counted and the largest diameter of each lymph node was measured and analyzed for metastatic involvement by histological examination.Results: A total of 698 lymph nodes were present in the 30 specimens examined for this study. A mean number of 23 (range, 19–39) lymph nodes was found in each specimen. Of these nodes, 566 (81%) were tumor-free and 132 (19%) contained metastases. The mean diameter of the lymph nodes free of metastases was 3.9 mm, whereas those infiltrated by metastases averaged 5.9 mm in diameter (P< 0.0001). Of the tumor-free lymph nodes, 528 (93%) measured < 5 mm in diameter, whereas 70 (53%) lymph nodes containing metastases measured < 5 mm in diameter.Conclusions: Lymph node size is not a reliable indicator for lymph node metastasis in colon cancer. A careful histological search for small lymph node metastasis in the specimen should be undertaken to avoid false-negative node staging.