国外低位直肠癌侧方转移淋巴结的清扫

目前国外对腹膜反折下低位进展期直肠癌的外科治疗研究集中在手术方式的合理选择、切除肿瘤远端肠管范围和保留肛门括约肌手术。有关清扫区域淋巴结转移范围 ,特别是侧方（平行）淋巴结转移的清扫不断增加。为了深入了解对局部复发率高的低位直肠癌术后复发的控制程度及提高５年生存率 ,本文对国外的有关进展作一概述。１直肠癌侧方淋巴结的转移率腹膜反折下（Ｒｂ）直肠的淋巴引流 ,虽主要向上方但也向下方和两侧髂内血管淋巴结输出 ,因而直肠癌发生部位的划分 ,应以腹膜反折为界（距肛缘约７ｃｍ左右）较为合理、实用。从局部解剖学角度而…     

前哨淋巴结示踪应用于宫颈癌的可行性和诊断盆腔淋巴结转移敏感性的Meta分析

摘 要：［目的］ 系统评价前哨淋巴结（sentinel lymph node,SLN）技术应用于早期宫颈癌的可行性及对淋巴结转移诊断的临床价值。［方法］ 计算机检索PubMed、 Embase、Cochrane Library以及万方等数据库,检索建库开始至2018年10月2日国内外关于SLN检测应用于早期宫颈癌的研究,通过QUADAS-2（Quality Assessment of Diagnostic Accuracy Studies-2）对文献进行质量评估,用Stata12.0软件对数据进行统计学分析,分析这些研究诊断淋巴结转移的敏感性。［结果］ 共纳入36个研究（3853例患者）,总的敏感性为0.91 ( 95％CI：0.88～0.93),I2=16.73%(95％CI：0～51.39%),汇总受试者曲线的ROC=0.99（0.98～1.00）。合并后的总检出率为97.10% (95%CI：96.50%～97.80%),异质性检验 I2=90.80%(P=0.000),合并后的双侧SLN检出率为69.20%(95%CI：62.80%～75.50%),异质性检验I2=95.70%(P=0.000),异质性较高,需要进行亚组分析。［结论］ SLN示踪技术应用于宫颈癌具有可行性,对于诊断宫颈癌淋巴结转移敏感性高,病理超分期对淋巴结转移诊断的优势还需更大样本量的结果来验证,示踪剂的选择、肿瘤的大小是双侧检出率的主要影响因素。     

低位直肠癌侧方淋巴结转移的影响因素

目的 分析低位直肠癌侧方淋巴结转移相关临床病理因素.方法 采用单因素和logistic多因素回归分析方法,分析低位直肠癌侧方淋巴结转移与其临床病理因素的关系.结果 患者性别、年龄、肿瘤位置、肿瘤占肠腔周径、Ki-67表达与侧方淋巴结转移无明显相关性,而肿瘤浸润深度、肿瘤直径、血清CEA含量、E-cad表达与侧方淋巴结转移相关.其影响作用大小的顺序为:浸润深度>血清CEA浓度>肿瘤最大直径>E-cad表达.结论 直肠癌侧方淋巴结转移率较低,不推荐常规行侧方淋巴结清扫;肿瘤浸润深度、肿瘤直径、血清CEA含量、E-cad表达是影响低位直肠癌侧方淋巴结转移的因素,对临床上手术方式的制定有一定参考价值.     

局部治疗在直肠癌盆腔侧方淋巴结转移中的作用北大核心CSCD

盆腔侧方淋巴结(LPLN)转移是直肠癌预后不佳因素, 在低位、T3-T4期、直肠系膜淋巴结阳性情况下更常见, 但无准确预测转移的因素。高分辨率MRI是目前诊断LPLN转移的首选手段, 但阈值选择仍不明确。局部进展期直肠癌的侧方淋巴结转移治疗模式在全球存在分歧, 欧美国家主张放化疗联合直肠全系膜切除术, 而日本推荐直肠全系膜切除术联合LPLN清扫。放疗与手术联合可取得很好的局控, 利用放疗前、后MRI的侧方淋巴结信息, 可筛选出高危患者进行强化治疗, 如放化疗后行LPLN清扫或LPLN区放疗推量。目前各种手段在治疗LPLN转移方面的作用仍缺乏高质量证据, 尚需更多的研究来改善治疗策略。     

PET/CT对宫颈癌淋巴结转移诊断价值的Meta分析

目的 采用Meta分析方法评价PET/CT在宫颈癌淋巴结转移诊断中的临床价值。方法 计算机检索PubMed、Web of Science、Cochrane Library、Embase.com、维普、万方、中国期刊全文数据库、中国生物医学文献数据库,并辅以手工检索,检索日期截止2013年7月11日,获取PET/CT诊断宫颈癌淋巴结转移的相关文献。2名研究者严格按照纳入排除标准独立地筛选文献、提取资料,依据QUADAS（quality assessment of diagnostic accuracy studies）工具进行文献质量评价,用Meta-Disc 1.4和Stata 12.0软件对其敏感度（SEN）、特异性（SPE）、阳性似然比（+LR）、阴性似然比（-LR）、诊断比值比（DOR）进行合并分析,并进行异质性检验,绘制综合受试者工作特征曲线（SROC）,并计算曲线下面积（AUR）。结果 检索获得1 006条记录,最终纳入26篇文献,其中英文文献23篇,中文文献3篇。Meta分析结果显示：SEN合并、SPE合并、+LR合并、-LR合并、DOR、AUROC,验前概率和验后概率分别为0.73（95%CI：0.70~0.76）、0.96（95%CI：0.95~0.96）,7.86(95%CI：5.30~11.65)、0.35（95%CI：0.28~0.45）、31.63（95%CI：17.17~58.25）、0.92（95%CI：0.89~0.94）、20%和73%。结论 PET/CT对比手术后病理诊断宫颈癌淋巴结转移有中度的敏感度和较好的特异性,可作为宫颈癌淋巴结转移的诊断方法之一。     

影像学诊断直肠癌转移淋巴结的研究进展

肿瘤TNM分期系统是评价结直肠癌患者预后的金标准和制定治疗方案的依据~[1]。分期越晚,术后局部复发率越高,Duke’s B、C期肿瘤复发率高于A期~[2]。随着肿瘤分期的准确性逐渐提高以及外科手术方案优化、辅助性放化疗的应用,直肠癌患者的术后生存率升高,但肿瘤局部复发依然是影响直肠癌患者生存的重要因素之一~[3]。淋巴结转移与直肠癌术后复发密切相关。约30%～40%直肠癌患者伴淋巴结转移,其中约40%发生于肠系膜     

低位直肠癌淋巴结转移的分析

目的:探讨腹膜返折以下直肠癌淋巴结转移的规律及其临床价值.方法:对行侧方淋巴结清扫的182例低位直肠癌病人进行回顾性分析.结果:腹膜返折以下直肠癌存在侧方淋巴结转移,转移率为16%,低分化腺癌及粘液腺癌侧方淋巴结转移率高.结论:侧方淋巴结转移是腹膜返折以下直肠癌淋巴转移的重要途径,低位进展期直肠癌应在上方淋巴结清扫的同时行侧方淋巴结清扫.     

低位直肠癌淋巴结转移的分析

目的:探讨腹膜返折以下直肠癌淋巴结转移的规律及其临床价值。方法:对行侧方淋巴结清扫的 182例低位直肠癌病人进行回顾性分析。结果:腹膜返折以下直肠癌存在侧方淋巴结转移,转移率为16％,低分化腺癌及粘液腺癌侧方淋巴结转移率高。结论:侧方淋巴结转移是腹膜返折以下直肠癌淋巴转移的重要途径,低位进展期直肠癌应在上方淋巴结清扫的同时行侧方淋巴结清扫。     

直肠癌侧方淋巴结转移及其清除的意义

目的：总结直肠癌病人侧方淋巴结转移率，方法：分析我院５４３例进展期直肠癌施行扩大根治术的结果。结果：直肠癌侧方转移率为９．６％，主要发生于腹膜返折以下的癌，多见于分比较差的低分化腺癌及粘液腺癌，结论：对于腹膜返折以下的进展期直肠癌必须进行侧方消除，尤其分化差者，可以提高生存率。     

MR成像对诊断直肠癌盆腔淋巴结转移的临床意义

目的 探讨磁共振(MR)成像对诊断直肠癌盆腔淋巴结转移的临床价值.方法 选择68例直肠癌患者,均行MR成像检查.观察MR图像中淋巴结的影像学特征,比较不同性质淋巴结特征及其长径、短径、表观扩散系数(ADC)值差异,并以手术病理结果为金标准,绘制受试者工作特征(ROC)曲线,分析ADC值诊断转移性淋巴结的效能.结果 68...     

A Logistic Model Including Risk Factors for Lymph Node Metastasis Can Improve the Accuracy of Magnetic Resonance Imaging Diagnosis of Rectal Cancer

Background: To evaluate use of magnetic resonance imaging (MRI) and a logistic model including risk factorsfor lymph node metastasis for improved diagnosis. Materials and Methods: The subjects were 176 patients withrectal cancer who underwent preoperative MRI. The longest lymph node diameter was measured and a cut-offvalue for positive lymph node metastasis was established based on a receiver operating characteristic (ROC) curve.A logistic model was constructed based on MRI findings and risk factors for lymph node metastasis extractedfrom logistic-regression analysis. The diagnostic capabilities of MRI alone and those of the logistic model werecompared using the area under the curve (AUC) of the ROC curve. Results: The cut-off value was a diameter of5.47 mm. Diagnosis using MRI had an accuracy of 65.9%, sensitivity 73.5%, specificity 61.3%, positive predictivevalue (PPV) 62.9%, and negative predictive value (NPV) 72.2% [AUC: 0.6739 (95%CI: 0.6016-0.7388)]. Age (<59)(p=0.0163), pT (T3+T4) (p=0.0001), and BMI (<23.5) (p=0.0003) were extracted as independent risk factors forlymph node metastasis. Diagnosis using MRI with the logistic model had an accuracy of 75.0%, sensitivity 72.3%,specificity 77.4%, PPV 74.1%, and NPV 75.8% [AUC: 0.7853 (95%CI: 0.7098-0.8454)], showing a significantlyimproved diagnostic capacity using the logistic model (p=0.0002). Conclusions: A logistic model including riskfactors for lymph node metastasis can improve the accuracy of MRI diagnosis of rectal cancer.     

直肠癌侧方淋巴结转移及其清除的意义

目的：总结直肠癌病人侧方淋巴结转移率。方法：分析我院543例进展期直肠癌施行扩大根治术的结果。结果；直肠癌侧方转移率为9．6％，主要发生于腹膜退折以下的癌，多见于分化较差的低分化腺癌及粘液腺癌。结论：对于腹膜返折以下的进展期直肠癌必须进行侧方清除，尤其分化差者．可以提高生存率。     

Performance of Indocyanine Green Fluorescence for Detecting Lymph Node Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis

Purpose: The use of sentinel lymph node dissection in several cancers has been gaining attention with the emergence of indocyanine green fluorescence. We performed a meta-analysis to assess the diagnostic performance of indocyanine green fluorescence in detecting lymph node metastasis in prostate cancer patients.Methods: A literature search was conducted using PubMed, Cochrane Library, and SCOPUS on November 30, 2020, to identify eligible studies. Studies were eligible if they investigated the diagnostic performance of indocyanine green fluorescence before pelvic lymph node dissection in prostate cancer patients and reported the number of true positives, false positives, false negatives, and true negatives on lymph node–based analysis in comparison to histopathologic findings in the dissected specimen.Results: Our systematic review covered 11 studies published between 2011 and 2020, with 519 patients, and our meta-analysis included 9 studies with 479 patients. Based on lymph node analysis of indocyanine green fluorescence, the results showed pooled sensitivity and specificity at 0.75 (95% confidence interval [CI] 0.49 to 0.90) and 0.66 (95% CI 0.61 to 0.70), respectively. The diagnostic odds ratio was 6.0 (95%CI 2 to 21). Several lymphatic drainage routes also showed sentinel lymph nodes localized outside the ordinal pelvic lymph node template.Conclusions: We noted relatively low diagnostic performance for lymph node metastasis, suggesting that indocyanine fluorescence may not currently be a viable alternative to pelvic lymph node dissection in prostate cancer patients. However, this technique shows novel lymphatic drainage routes and underscores the importance of lymph nodes not removed in ordinary dissection.     

102例直肠癌侧方淋巴结转移患者临床病理特点及生存预后分析

Objective To investigate the therapeutic effect and prognostic significance of lateral lymph node dissection (LPLND) in patients with lateral lymph node (LPLN) metastasis. Methods The clinicopathological data of rectal cancer patients who underwent total mesorectal excision (TME) combined with LPLND and pathologically confirmed as LPLN metastasis after operation were retrospectively analyzed. The clinicopathological characteristics and metastasis rules of patients with LPLN metastasis were discussed, and the survival prognosis after LPLND was analyzed. Results A total of 102 rectal cancer patients with pathologically confirmed LPLN metastasis were included. The common sites of LPLN metastasis were internal iliac vessels lymph nodes (n=68, 66.7%), followed by obturator lymph nodes (n=44, 43.1%), and common iliac vessels or external iliac vessels lymph nodes (n=12, 11.8%). There were 10 patients (9.8%) with bilateral LPLN metastases, and the mean number of LPLN metastases was 2.2±2.4, among which 16 patients (15.7%) had LPLN metastases number≥2. The 3-year OS (66.8% vs. 7.7%, P<0.001) and DFS (39.1% vs. 10.5%, P=0.012) of patients with LPLN metastases to the external iliac or common iliac lymph node were significantly lower than those with metastases to the internal iliac or obturator lymph node. The multivariate analysis showed that LPLN metastasis to external iliac or common iliac lymph node was an independent risk factor both for OS (HR=3.53; 95%CI: 1.50-8.31; P=0.004) and DFS (HR=2.40; 95%CI: 1.05-5.47; P=0.037). Conclusion LPLN mainly metastasizes to the internal iliac or obturator lymph node areas. The survival of patients with metastasis to the external iliac or common iliac lymph node cannot be improved by LPLND, and thus systemic comprehensive treatment is often the optimal treatment option. © 2023, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

胃癌组织中COX-2的表达及其与淋巴结转移相关性的Meta分析

目的研究胃癌组织中环氧合酶-2（COX-2）的表达及其与淋巴结转移之间的关系。方法综合分析自2005年1月至今公开发表的有关COX-2与胃癌发生、淋巴结转移关系的文献资料,按照文献入选标准,有13项随机对照实验纳入本次研究,应用RevMan5.0.17软件进行统计分析。结果COX-2在胃癌组织中的表达显著高于正常组织,OR=24.70,95%CI：15.93~38.31,在肿瘤转移组中COX-2的表达明显高于非转移组,OR=4.94,95%CI：3.50~6.77。结论COX-2高表达与胃癌的发生有统计学关联,并与淋巴结转移相关。     

CT对原发性肺癌合并肺门,纵隔淋巴结转移的诊断价值

本文报告50例原发性肺癌病人肺门、纵隔等处摘出的210个淋巴结的病理诊断与胸部CT对照研究,探讨CT诊断肺癌淋巴结转移的价值和转移淋巴结的大小阀值。结果表明CT对诊断肺癌淋巴结转移有重要价值,但在发现某些部位的淋巴结肿大和判断转移的特异性方面有一定限制。在CT上显影的164个淋巴结中,若以长径>15mm作为淋巴结转移的阀值,则敏感性为57％,特异性为91％,准确性为81％,阳性预期值(PPV)71％,阴性预期值(NPV)84％。有46个淋巴结(22％)在CT上未能显示,主要是叶支气管周围及肺韧带淋巴结。作者指出,对肺癌合并肺门、纵隔淋巴结转移的诊断要慎重。     

非小细胞肺癌淋巴结大小与转移的关系

目的:评估非小细胞肺癌淋巴结大小与转移的相关性.方法:从形态测量学角度,分析258例非小细胞肺癌患者纵隔和肺门的淋巴结.记录每例淋巴结数目、最大径及病理结果.计算转移频数与淋巴结大小的相关性.回顾性分析其中80例患者术前CT扫描的淋巴结所见,与组织病理学诊断相对照.结果:检查258例标本的2 892枚淋巴结.140例患者为pN0期,118例为淋巴结阳性.2 487枚淋巴结(86.0%)无转移,405枚淋巴结(14.0%)有转移.无转移淋巴结平均直径是(7.05±3.7)mm,转移淋巴结是(10.7±4.7)mm,(P＜0.005).1 954枚无转移淋巴结(78.5%)和180枚转移淋巴结(44.3%)直径＜10mm.140例无转移淋巴结的患者中,102例(72.9%)至少有一枚淋巴结＞10mm118例转移患者中,13.0%淋巴结＜10mm.80例CT扫描评估的敏感性是57.0%,特异性80.2%结论:淋巴结大小不能作为评估非小细胞肺癌转移浸润的可靠参数.