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1.
Background The influence of patient age on the risk of sentinel lymph node (SLN) metastasis in breast cancer has not been defined.
Methods A breast cancer SLN database was analyzed. Factors associated with SLN metastasis were assessed by multiple logistic regression
modeling. Age, T stage, estrogen receptor status, HER-2/neu status, grade, angiolymphatic invasion, lobular histology, tubular/mucinous
histology, and the number of SLNs resected were assessed.
Results Data were available for 810 patients with invasive breast cancer. SLN metastasis was observed in 22% of the patients. The
factors most strongly associated with SLN metastasis were angiolymphatic invasion, T stage, and age. Age ranged from 29 to
95 years. The median age was 66 years. Overall, SLN metastasis was more common in younger patients (≤66 years) than in older
patients (>66 years; P < .001). Among patients without angiolymphatic invasion, SLN metastasis was nearly twice as common in the younger patients
as in the older patients. The effect of angiolymphatic invasion as a risk for SLN metastasis was much greater in the older
age group.
Conclusions In addition to known risk factors, age independently predicts the risk of SLN metastasis in breast cancer. Angiolymphatic
invasion seems to be a more powerful predictor of SLN metastasis in older patients. 相似文献
2.
Taner Yilmaz G?khan Gediko?lu Bülent Gürsel 《Otolaryngology--head and neck surgery》2003,129(3):192-198
OBJECTIVES: We sought to determine the relationship of tumor thickness to clinical and histopathologic parameters in laryngeal cancer.Study design and setting We conducted a retrospective review of laryngectomy specimens of 111 surgically treated T1-3 laryngeal cancer patients for tumor thickness and various histopathologic parameters. RESULTS: Tumor thickness was significantly related to T, N, and clinical stage; pathologic cervical lymph node metastasis; cartilage invasion; microscopic appearance; mode of invasion to surrounding tissues; perineural invasion; and lymphocytic infiltration (P < 0.05). Tumor thickness had significant correlation with T, N, and clinical stage; cervical lymph node metastasis; cartilage invasion; mode of invasion to surrounding tissues; perineural invasion; and lymphocytic infiltration (P < 0.05). Multifactorial statistical analysis showed that cartilage invasion and lymphocytic infiltration significantly determined tumor thickness independently (P < 0.05). CONCLUSION: Tumor thickness is well correlated to most of the reliable clinical and histopathologic parameters, and it is an objective and easy-to-obtain measure. SIGNIFICANCE: Tumor thickness can be used as a reliable histopathological factor and should be measured in every laryngectomy specimen. 相似文献
3.
Surgical Management of Early Colorectal Cancer 总被引:4,自引:0,他引:4
Nivatvongs S 《World journal of surgery》2000,24(9):1052-1055
An early colorectal carcinoma is TNM stage T1NxMx. Most early carcinomas of the colon and rectum can be treated by adequate
local excision, such as colonoscopic polypectomy and per-anal excision. If there are adverse risk factors, especially poorly
differentiated carcinoma, lymphovascular invasion, or incomplete excision, a radical resection is indicated if there is no
contraindication. In the case of a low rectal carcinoma, adjuvant chemoradiation should be considered. Recently a new classification
has been developed: sm1 is invasion to the upper one-third of the submucosa, sm2 is invasion to the middle one-third, and
sm3 is invasion to the lower one-third. Lesions of sm1 and sm2 have a low risk of local recurrence and lymph node metastasis;
local excision is adequate. The sm3 lesions and sm2 flat and depressed types have a high risk of local recurrence and lymph
node metastasis; further treatment is indicated.
E-pub: 3 July 2000 相似文献
4.
5.
Because of the rarity of mediastinal lymph node metastasis, no evidence exists regarding risk factors indicating its presence.
This study aimed to identify risk factors representing potential triggers of imaging for mediastinal lymph node metastasis.
Carried out was an analysis of 392 consecutive patients with node-positive papillary thyroid cancer referred to a tertiary
surgical center. Significant univariate associations (P ≤ 0.001) existed, after correction for multiple testing, between mediastinal lymph node metastasis and poor tumor differentiation
(24% versus 2%), number of positive lymph nodes (mean 14.4 versus 7.3 nodes), and distant metastasis (43% versus 11%). Only
nominally significant were age at first tumor diagnosis (47.7 versus 39.1 years; P = 0.042), extrathyroidal tumor extension (76% versus 53%; P = 0.044), and bilateral lymph node metastasis (81% versus 49%; P = 0.006). In the initial and optimized multivariate logistic regression models, which included all significant variables from
the above analysis, only poor tumor differentiation (odds ratio 11.6–14.6) and distant metastasis (odds ratio 5.4–6.1) represented
significant (P ≤ 0.005) predictors of mediastinal lymph node metastasis. These two variables featured excellent negative predictive values
of 96%. Regarding prediction of mediastinal lymph node metastasis, poor tumor differentiation was more discriminatory than
distant metastasis, as reflected in a better accuracy (94% versus 86%) and positive predictive value (42% versus 18%). We
conclude that, subject to validation in independent series, patients with poorly differentiated papillary thyroid cancers,
which are rare, should be ideal candidates for mediastinal imaging because 5 of 12 patients (42%) having this condition in
the present investigation harbored mediastinal lymph node metastasis. 相似文献
6.
目的:探讨胆囊癌的临床病理特点及淋巴转移的临床病理危险因素。方法:回顾性分析2013年3月—2018年3月收治的50例胆囊癌患者的临床资料,对其临床病理特点进行总结,对患者淋巴转移的临床病理因素进行单因素和多因素分析。结果:50例患者中,女性比例高于男性(男女比例为2:3);7例患者无任何症状,43例有不同程度的上腹痛、恶心呕吐、乏力、体质量或食欲下降等;肿瘤部位以胆囊体底部居多(58.0%),T分期以T3~T4为主(78.0%),多数组织学分级恶性度较高(G3~G4者占64.0%),有淋巴转移者32例(64.0%)。单因素分析显示,肿瘤部位、T分期、组织学分级、远处转移、血管浸润、肝脏侵犯和血清CEA水平与患者淋巴结转移明显有关(均P0.05)。Logistic多元回归模型分析结果显示,肿瘤部位、T分期、组织学分级、远处转移为胆囊癌患者淋巴转移的独立危险因素(均P0.05)。结论:胆囊癌患者中女性较多,淋巴转移常见。多种因素与患者淋巴转移密切相关。临床针对这些患者在术中应仔细清扫淋巴组织,避免局部复发及远处转移,以期延长患者生存时间。 相似文献
7.
Yoder BJ Rufforny I Massoll NA Wilkinson EJ 《The American journal of surgical pathology》2008,32(5):765-772
Early invasive vulvar squamous cell carcinoma (SCC) with less than 1.0 mm of invasion (FIGO stage IA) has been shown to have a minimal risk of lymph node metastasis and is associated with an excellent prognosis. The prognostic significance of other histologic parameters other than depth of invasion, however, remains controversial. Seventy-eight consecutive cases of vulvar SCC having a depth of invasion of 5.0 mm or less were reviewed and the clinical outcome compared with the type of surgical excision, the presence of concurrent lymph node metastases, the depth of tumor invasion, the tumor thickness, the tumor horizontal spread, the estimated tumor volume, tumor histologic subtype, tumor histologic grade, tumor pattern of invasion, tumor multifocality, presence of perineural invasion, presence of angiolymphatic invasion and the presence of precursor lesions, including the type of vulvar intraepithelial neoplasia and presence of lichen sclerosus. The only histologic feature for predicting concurrent lymph node metastasis was tumor depth of invasion. The 3 most important features of stage IA tumors in predicting tumor recurrence were the depth of invasion, presence of SCC at the surgical margins, and the histologic grade. 相似文献
8.
Carcinomatous Lymphatic Invasion in Early Gastric Cancer Invading Into the Submucosa 总被引:5,自引:0,他引:5
Sumiya Ishigami MD Shoji Natsugoe MD Shuuichi Hokita MD Masahiro Tokushige MD Tetsushi Saihara MD Teruhiko Watanabe MD Kuniaki Aridome MD Hirohumi Iwashige MD Takashi Aikou MD 《Annals of surgical oncology》1999,6(3):286-289
Background: Lymphatic invasion is a risk factor for lymph node metastases in patients with gastric cancer. No studies have been reported, however, on the correlation between lymphatic invasion and lymph node metastasis in early gastric cancer invading into the submucosa.Methods: We performed a retrospective analysis of lymphatic invasion in 170 patients with early gastric cancer invading into the submucosa.Results: Lymphatic invasion was found in 76 patients. Lymphatic invasion correlated significantly with the presence of lymph node metastasis and vascular invasion (P < .05) and with the degree of cancerous submucosal involvement (P < .05). The presence of lymph node metastasis also correlated with the grade of submucosal invasion and lymphatic invasion. The 5-year survival of patients with lymphatic invasion was poorer than that of patients without lymphatic invasion (P < .05). Node-negative patients had similar survival, regardless of the presence of lymphatic invasion. All patients with severe lymphatic invasion had sm3 invasion and lymph node metastases.Conclusion: Although lymphatic invasion is the first stage of lymph node metastasis, lymphatic invasion in itself does not have clinical importance except for severe invasion in early gastric cancer. It is possible to predict lymph node metastases from the combined evaluation of degree of lymphatic invasion and submucosal involvement of the tumor in patients with early gastric cancer invading into the submucosa. 相似文献
9.
Tsutomu Namieno Kazumitsu Koito Tsunemi Higashi Tsuyoshi Shimamura Kenichiro Yamashita Yukifumi Kondo 《World journal of surgery》1998,22(8):869-873
p
< 0.02) more recurrent than mucosal ones (0.29%). Of the 16 patients with recurrence, 10 (62.5%) died within 5 years after
surgery, frequently because of blood-borne metastasis. Macroscopically elevated components, the degree of histologic differentiation,
and lymph node metastasis significantly contributed to the postoperative recurrence. After detailed analysis of submucosal
carcinomas, it is strongly suspected that carcinomas with a macroscopically elevated component were significantly associated
with nodal involvement and microvessel invasion, and that these abnormalities lead to recurrence. Among the early gastric
carcinomas, differentiated submucosal carcinomas with a macroscopically elevated component, lymph node metastasis, or both
have the most potential of recurrence after surgery. Mucosal carcinomas must be restricted to limited surgery, but, blood-borne
metastasis should be carefully avoided. 相似文献
10.
Nakagoe T Sawai T Tsuji T Hidaka S Tanaka K Shibasaki S Nanashima A Yamaguchi H Yasutake T 《International surgery》2004,89(1):10-14
An additional resection is indicated when colorectal polyps resected by colonoscopy reveal T1 carcinoma with unfavorable histology (no free margin or having risk factors for lymph node metastasis). We describe our experience with this type of surgery with the minilaparotomy approach (< or = 7 cm). This prospective study included 19 consecutive patients between 1997 and 2001. Specimens resected by colonoscopy revealed T1 carcinomas with one of the following histological types: inadequate excision (no free margin), lymph-vascular invasion, histologic grade III, or sm2/sm3 (submucosal invasion greater than 200-300 microm from the muscularis mucosa). The minilaparotomy approach included 15 colectomies and 4 anterior resections. Median length of minilaparotomy was 7 cm (range, 4-7 cm). Median number of lymph nodes removed was 11 (range, 7-21 lymph nodes). Median proximal and distal margins were 9.0 (range, 5.2-17.5 cm) and 8.5 cm (range, 2.0-11.5 cm), respectively. The patients quickly returned to normal function without morbidity and mortality. Five (26.3%) had a residual carcinoma within the bowel wall, and one (5.3%) had lymph node metastasis. At a median follow-up of 33.6 months, one patient (5.3%) developed local recurrence and subsequent distant metastasis. The minilaparotomy approach is suitable for an additional operation following colonoscopic polypectomy for T1 carcinoma, thus providing a minimally invasive alternative to conventional laparotomy. 相似文献
11.
目的 探讨T2胸中段食管鳞癌淋巴结转移特点和规律.方法 分析246例接受颈、胸、腹三野淋巴结清扫的T2胸中段食管鳞癌病人的临床病理指标与淋巴结转移的关系.结果 每例病人清扫淋巴结15~59枚,平均25枚.其中129例存在区域淋巴结转移.颈、胸和腹三区淋巴结转移率分别为28.9%、28.5%和22.0%,差异无统计学意义.Logistic回归模型显示肿瘤长度、肿瘤细胞分化程度及有无淋巴管血管浸润是影响淋巴结转移的有意义因素.结论 T2胸中段食管鳞癌淋巴结转移与肿瘤长度、肿瘤细胞分化程度及有无淋巴管血管浸润明显相关;T2胸中段食管鳞癌有上、下双向转移和跳跃性转移的特点,应行三野淋巴结清扫,对胸中段超出T2的食管鳞癌也应行以上手术.Abstract: Objective To investigate the pattern of lymph node metastasis in patients with 17 and middle thoracic esophageal squamous cell carcinoma( ESCC). Methods Retrospective review the clinical data of 246 cases with T2 and middle thoracic esophageal squamous cell carcinoma who were treated by three-field lymphadenectomy. Analyze the relationship between clinical pathological factors and lymph node metastasis. Results Lymph node metastases were found in 129 of the 246 patients (52.4% ).The average number of resected lymph nodes was 25 per patient (rangel5 -59). The rates of lymph node metastasis were 28.9% in the neck, 28.5% in thoracic mediastinum and 22.0% in abdominal cavity for patients with T2 and middle thoracic ESCC. No significant difference in lymph node metastasis' rate was observed among the neck, thoracic mediastinum and abdominal cavity. Logistic-regression showed the length of tumor, tumor cell differentiation and angiolymphatic invasion were factors influencing lymph node metastasis. Conclusion Lymph node metastasis in T2 and middle thoracic ESCC has the characteristics of upward, downward and skip spreading. Patients with T2 and middle thoracic ESCC should be treated with radical surgery with three-field lymphadenectomy. 相似文献
12.
S. Rasheed D. M. Bowley O. Aziz‡ P. P. Tekkis‡ A. E. Sadat† T. Guenther† M. L. Boello P. J. McDonald I. C. Talbot† J. M. A. Northover 《Colorectal disease》2008,10(3):231-238
Objective The present study investigated the risk of lymph node metastasis according to the depth of tumour invasion in patients undergoing resection for rectal cancer. Method The histology of patients undergoing oncological resection with regional lymphadenectomy for rectal cancer at St Marks Hospital from 1971 to 1996 was reviewed. Of the total number of 1549 patients, 303 patients with T1 or T2 rectal cancers were selected. The tumour type, grade, evidence of vascular invasion, depth of submucosal invasion (classed into ‘sm1‐3’) were evaluated as potential predictors of lymph node positivity using univariate and multi‐level logistic regression analysis. Results Tumour stage was classified as T1 in 55 (18.2%) and T2 in 248 (81.2%) patients. The incidence of lymph node metastasis in the T1 group was 12.7% (7/55), compared to 19% (47/247) in the T2 group. The node positive and negative groups were similar with regard to patient demographics, although the former contained a significantly higher number of poorly differentiated (P = 0.001) and extramural vascular invasion tumours (P = 0.002). There was no significant difference in the number of patients with sm1‐3, or T2 tumour depths within the lymph node positive and negative groups. On multivariate analysis the presence of extramural vascular invasion (odds ratio = 10.0) and tumour grade (odds ratio for poorly vs well‐differentiated = 11.7) were independent predictors of lymph node metastasis. Conclusion Whilst the degree of vascular invasion and poor differentiation of rectal tumours were significant risk factors for lymph node metastasis, depth of submucosal invasion was not. This has important implications for patients with superficial early rectal cancers in whom local excision is being considered. 相似文献
13.
Masanori Tokunaga MD Shigekazu Ohyama MD PhD Naoki Hiki MD PhD Tetsu Fukunaga MD PhD Harutaka Inoue MD PhD Kazuhiko Yamada MD PhD Takeshi Sano MD PhD Toshiharu Yamaguchi MD PhD Toshifusa Nakajima MD PhD 《Annals of surgical oncology》2009,16(5):1241-1246
Background In advanced gastric cancer (AGC) with duodenum invasion, the posterior pancreatic lymph nodes are susceptible to metastasis
because of their proximity to the duodenum. The therapeutic value of lymph node dissection in this area for AGC with macroscopic
duodenum invasion remains unclear.
Methods Patients who had undergone curative gastrectomy for lower-third AGC from 1970 to 2004 at the Cancer Institute Hospital were
recruited for this study. Clinicopathological data were collected retrospectively, and compared between cases of AGC with
duodenum invasion (AGC-DI group) and AGC without duodenum invasion (AGC-nDI group). In the AGC-DI group, the therapeutic value
of lymph node dissection was evaluated using a therapeutic index (multiplication of the frequency of metastasis to the station
by the 5-year survival rate of patients with metastasis to that station).
Results The AGC-DI group generally had tumors of higher pathological stage, which might account for the poorer 5-year survival rate
compared with that of the AGC-nDI group (50.1% versus 68.5%; P = 0.0002). The incidence of lymph node metastasis was higher in the AGC-DI group than that in the AGC-nDI group, including
nodes in the posterior pancreatic head (23.9% versus 7.0%, P < 0.0001). In the AGC-DI group, posterior pancreatic head lymph node dissection was of therapeutic value (4.19) equivalent
to dissection of second-tier lymph nodes.
Conclusions The dissection of posterior pancreatic head lymph nodes might be effective in AGC with macroscopic duodenum invasion since
this has therapeutic value equivalent to that of second-tier lymph node dissection and might improve patients’ long-term outcomes. 相似文献
14.
Central Cervical Nodal Metastasis from Papillary Thyroid Microcarcinoma: Pattern and Factors Predictive of Nodal Metastasis 总被引:1,自引:0,他引:1
Background Although several factors are thought to predict the occurrence of lymph node metastases from papillary thyroid microcarcinoma
(PTMC), the pattern of nodal metastasis has been rarely studied. We evaluated the pattern and factors predictive of central
cervical metastasis from PTMC.
Methods Seventy-two patients with PTMC underwent total thyroidectomy and central neck dissection, including three who underwent therapeutic
modified radical neck dissection. Lymph node involvement was analyzed by neck subsite, and clinicopathologic variables predictive
of nodal metastasis were determined.
Results Central and lateral nodal metastases were found in 29 (40.3%) and 3 (4.2%) patients, respectively, and ipsilateral paratracheal,
pretracheal, superior mediastinal, and contralateral paratracheal lymph node metastases in 27 (37.5%), 8 (11.1%), 4 (5.6%),
and 1 (1.4%), respectively. Sex, age, tumor size, multifocality, bilaterality, extracapsular invasion, lymphovascular invasion,
and MACIS (metastases, age, completeness of resection, invasion, size) for central node metastasis were not predictive of
metastasis (P > .1). Temporary and permanent hypocalcemia was observed in 17 (23.6%) and 1 (1.4%) patients, respectively, and transient
vocal fold paralysis in 1 (1.4%).
Conclusion Despite the absence of palpable neck nodes, PTMC is associated with a high rate of central lymph node metastasis to ipsilateral
and pretracheal subsites. No clinicopathologic factor predicted nodal metastasis. In patients with PTMC involving one lobe
and positive nodes, neck dissection may exclude the contralateral side. 相似文献
15.
Objective Patients with head and neck squamous cell carcinoma (SCC) often present with cervical lymph node metastasis. Occasionally
the primary tumor site remains unknown even after thorough investigation. Management of such cases is problematic and may
result in over-treatment and consequent increased morbidity. High risk HPV has been advocated recently as an important etiologic
factor for a subset of head and neck SCC. These are believed to have a special predilection for the oropharyngeal tonsils
and are characterized by nonkeratinizing basaloid morphology, and a strong reactivity to p16 immunostain. Identifying HPV-related
SCC in the lymph nodes may thus provide a means for localizing the primary tumor site. Design Ninety-three cases of SCC metastatic to the neck from known primary tumors were classified morphologically into conventional
keratinizing SCC (KSCC) and non-keratinizing SCC (NKCa). In situ hybridization (ISH) for high risk HPV as well as immunostaining
for p16 were performed on all metastsatic and primary tumors. Results Of the 93 cases of metastatic carcinomas 32 were oropharyngeal, 35 oral, and 26 arose in the laryx/hypopharynx. Twenty-three
cases were found to be HPV+ by ISH, of which 22/23 had oropharyngeal origin (P < 0.0001), with 95.7% sensitivity and 85.7% specificity. Twenty-one of these HPV+ oropharyngeal tumors were NKCa (P < 0.0001). The remaining case showed overlapping NKCa/KSCC hybrid morphology. All NKCa were HPV+ and stained diffusely and
strongly with p16 antibodies. Conclusion We have demonstrated that HPV status of the lymph node metastasis can be assessed not only by ISH and p16 immunoreactivity
but also histomorphologically. In addition, a positive microscopic identification of HPV-related carcinoma is a reliable predictor
of oropharyngeal origin. 相似文献
16.
Wagner PL Moo TA Arora N Liu YF Zarnegar R Scognamiglio T Fahey TJ 《Annals of surgical oncology》2008,15(10):2833-2841
Background Functional chemokine receptors are expressed in many malignant tumors, including papillary thyroid carcinoma (PTC). These
receptors promote tumor growth and metastasis in response to endogenous chemokines. The purpose of this study was to examine
the expression of two chemokine receptors—CXCR4 and CCR7—in a series of PTCs. We hypothesized that CXCR4 and CCR7 would correlate
with indicators of tumor aggressiveness, including tumor size, extrathyroidal extension (ETE), angiolymphatic invasion (ALI),
and lymph node metastasis.
Methods CXCR4 and CCR7, as well as their specific chemokine ligands (CXCL12 and CCL21, respectively), were assessed in 88 PTCs from
65 patients using a semiquantitative measure of immunohistochemical (IHC) staining intensity for each molecule. Staining intensity
was compared with clinicopathologic features including patient age, gender, tumor size, multifocality, ETE, ALI, and lymph
node metastasis. Differences in CXCR4 and CCR7 mRNA levels were sought in a subset of tumors using gene microarrays and quantitative
RT-PCR. [Statistics: t test, Mann-Whitney U test; P < .05].
Results High-intensity IHC staining for CXCR4 was associated with larger tumor size (P = .02), while PTCs exhibiting ETE, ALI, or lymph node metastasis showed higher-intensity IHC staining for CCR7 than those
without (P = .01, .03, and .01, respectively). CCR7 mRNA levels were also higher in tumors with ALI (P = .04).
Conclusion Expression of CXCR4 and CCR7 by PTCs is associated with indicators of tumor aggressiveness, including tumor size, ETE, ALI,
and lymph node metastasis. Further studies are necessary to define the mechanisms underlying this association and to determine
its potential prognostic and therapeutic implications. 相似文献
17.
M Takashi T Nagai T Murase K Miyake N Hamajima S Mizuno 《Urologia internationalis》1989,44(3):125-131
To elucidate the relative importance of clinicopathologic factors affecting regional lymph node metastasis and survival in bladder cancer patients, multivariate analyses by the logistic regression model and proportional hazards model were performed for 86 patients who underwent radical cystectomy between 1978 and 1988. Clinicopathologic factors included in the analysis were sex, age, prior tumor history, time from onset of symptoms to cystectomy, and tumor characteristics (size, number, growth pattern, grade, stage, infiltration pattern, lymphatic invasion, lymphocytic infiltration around tumors, and lymph node metastasis). Nineteen of eighty-six patients (22%) had regional lymph node metastasis. Univariate analysis showed that lymph node metastasis was related to stage (p = 0.0006), lymphatic invasion (p = 0.006) and infiltration pattern (p = 0.02). Multivariate analysis revealed that stage is the only determinant of statistical significance for lymph node metastasis. High-stage tumors (pT3a-pT4) had 15 times higher risk for lymph node metastasis than low-stage tumors (pTis-pT2). The 5-year survival rates were 25 and 75% for patients with and without lymph node metastasis, respectively. Proportional hazards model revealed that stage is the most significant determinant (p = 0.0001) for survival, followed by lymph node metastasis with borderline significance (0.005 less than p less than 0.1). A two-factor model consisting of stage and lymph node metastasis yielded corrected hazard ratios of 14.7 for stage and 2.3 for lymph node metastasis. The present study quantitatively confirms previous univariate analyses of factors affecting lymph node metastasis and survival in patients undergoing radical cystectomy. 相似文献
18.
CRP Genetic Polymorphism Is Associated with Lymph Node Metastasis in Thoracic Esophageal Squamous Cell Cancer 总被引:1,自引:0,他引:1
Satoru Motoyama MD PhD Masatomo Miura PhD Yudai Hinai PhD Kiyotomi Maruyama MD PhD Shuetsu Usami MD Hajime Saito MD PhD Yoshihiro Minamiya MD PhD Shigeru Satoh MD PhD Katsuyuki Murata MD PhD Toshio Suzuki PhD Jun-ichi Ogawa MD PhD 《Annals of surgical oncology》2009,16(9):2479-2485
Background Lymph node involvement is the most important prognostic factor in thoracic esophageal cancer. A more accurate molecular technique
for diagnosing lymph node metastasis and a better understanding of the molecular mechanisms governing lymph node metastasis
would be highly desirable. The purpose of this study is to examine the association between inflammation-related genetic polymorphisms
and lymph node metastasis.
Methods The study participants were 113 Japanese patients undergoing curative surgery for thoracic esophageal squamous cell cancer.
DNA was extracted from blood samples and genetic polymorphisms in C-reactive protein (CRP), tumor necrosis factor (TNF)-α
and -β, interferon (IFN)-γ, transforming growth factor (TGF)- β, interleukin (IL)-1β, IL-1 receptor antagonist, IL-2, IL-4,
IL-6, IL-6 receptor, IL-10, and IL-12β were investigated using the polymerase chain reaction–restriction fragment length polymorphism
method. We then assessed the association between inflammation-related genes and lymph node metastasis.
Results For CRP 1846C>T polymorphism, the frequency of the 1846T/T genotype was significantly higher in patients with lymph node metastasis
(P = 0.0043), and the odds ratio (3.040) derived from logistic regression models indicated that the 1846T/T genotype significantly
increases the likelihood of lymph node metastasis. In submucosal cancer, the utility of CRP 1846C>T polymorphism for predicting
lymph node involvement was superior to usual methods (computed tomography and ultrasonography), with positive and negative
predictive values of 69% and 75%, respectively.
Conclusions These findings suggest that CRP polymorphism is a potentially effective predictor of lymph node metastasis and may thus be
useful for deciding on treatment strategy. 相似文献
19.
Zhao Y Jiang Y Wang R Zheng X Wang X Jin B Lu Y Qiao T Hong L Fan D 《Annals of surgical oncology》2007,14(9):2621-2627
Purpose MG7-Ag is a human gastric-carcinoma-associated antigen. The expression of MG7-Ag was found to increase gradually with the
development and progression of gastric cancer. Moreover, a poorer prognosis was found in MG7-Ag positive gastric-carcinoma
patients than in MG7-Ag negative patients. However, neither MG7-Ag expression nor its clinical significance has been previously
examined in squamous cell carcinoma (SCC) of the esophagus. In this study, we examined the expression of MG7-Ag in esophageal
squamous cell carcinomas to assess its value as a prognostic indicator.
Methods The expression of MG7-Ag was detected in 112 cases of esophageal squamous cell carcinoma (SCC) by immunohistochemical analysis.
The relation of MG7-Ag staining with various clinicopathological features was statistically analyzed.
Results The staining of MG7-Ag was detected in SCC, while not in normal epithelial cells. In esophageal SCC, MG7-Ag was found significantly
correlated with depth of invasion (P = .012), in T4, T3 carcinomas but not in T2, T1 carcinomas, lymph node metastases (P = .029), pathological stage (P = .005). Consistently, the survival rate tended to be statistically lower in patients with MG7-Ag positive SCCs than in MG7-Ag
negative SCCs (P = .005). However, no significant difference was observed between MG7-expression and patient age, sex, tumor location, differentiation,
distant metastasis, and lymphatic invasion.
Conclusion MG7-Ag might play a positive role in the process of carcinogenesis and progression of esophageal SCC, and it could be considered
as one valuable prognostic indicator in esophageal SCC. 相似文献
20.
Dacic S Ionescu DN Finkelstein S Yousem SA 《The American journal of surgical pathology》2005,29(7):897-902
Distinction of multiple primary lung carcinomas from intrapulmonary metastases using empiric clinical and histopathologic criteria can be difficult. Recent advances have provided several molecular markers that can be used for clonal analysis of separate tumor nodules and enhance tumor staging and subsequent treatment and prognosis. To address this issue, we performed a microdissection-based allelotyping of 20 cases of histologically similar, pathologic stage T4 adenocarcinomas (ADCs). Loss of heterozygosity (LOH) analysis included a panel of 15 polymorphic microsatellite markers located on 1p, 3p, 5q, 9p, 9q, 10q, 17p, and 22q. The tumor size, visceral pleural and angiolymphatic invasion, lymph node status, outcome, and survival were assessed. Allelotypes of 60 cases of solitary primary non-small cell lung carcinomas (NSCLC) (stages I-II) were used to define the percentage of discordant LOH patterns within solitary primary lung carcinoma that would discriminate between survivors and nonsurvivors. These criteria were used in the analysis of pathologic stage T4 ADC. Two groups of stage T4 cases were created: molecularly homogenous (< or = 40% discordances) (14 cases, 70%), and molecularly heterogenous (>40% discordances) (6 cases, 30%). Molecularly homogenous tumors were more frequently associated with visceral pleural invasion (92% vs. 8%) (P = 0.018). Allelotype did not correlate with age, gender, tumor size, tumor differentiation, lymph node status, angiolymphatic invasion, survival, or outcome. Our study showed that discordant and concordant genotypic profiles exist in morphologically similar synchronous ADC of the lung. 相似文献