Risk factors and prognostic value of lymph node metastasis in patients undergoing curative resection for intrahepatic cholangiocarcinoma

Objective To analyze the related factors of lymph node metastasis in N2 group of patients with non-small cell lung cancer, and found its meaning for lymph node dissection. Methods A retrospective analysis was made on 110 patients with non-small cell lung cancer from July 2014 to May 2016 in our thoracic surgery department. Potential related factors were collected, single factor analysis and variate analysis were carried out to find the relationship between N2 lymph node metastasis and potential related factors. Results Univariate analysis showed that the longest diameter of the tumor >2 cm (P=0.016), lymph node imaging (P=0.021), pleural involvement (P=0.002) were related factors of lymph node metastasis in N2 group, and these three factors were independent related factors of lymph node metastasis in N2 group. Conclusions The longest diameter of the tumor, lymph node imaging and pleural involvement are related factors of N2 lymph node metastasis. Systematic lymph node dissection is strongly recommended for patients with three related factors at the same time. Key words: Carcinoma, non-small-cell lung; Lymphatic metastasis; Risk factors; Lymph node excision

BackgroundPelvic lymph node metastasis (LNM) is a crucial independent prognostic factor in cervical cancer (CCa) and serves as an indicator for radiation therapy as the primary or an adjuvant treatment option. However, preoperative diagnosis of LNM remains challenging. Thus, we aimed to identify biomarkers of LNM in patients with presumed early-stage CCa.MethodsThe differentially expressed genes (DEGs) between tumours with different lymph node statuses were identified by using The Cancer Genome Atlas database. Then, univariate Cox regression analysis and Kaplan–Meier analyses were utilized to screen overall survival (OS)-associated genes. Multivariate Cox analysis and logistical analysis were utilized to evaluate independent risk factors for OS and LNM, respectively. Subsequently, the protein level of fatty acid binding protein 4 (FABP4) was detected in normal cervical and CCa tissues by immunohistochemistry assays. EdU assays were performed to determine whether FABP4 altered the proliferation of cervical cancer cells. Wound healing and Transwell assays were conducted to explore the effects of FABP4 depletion on migratory and invasive abilities of cervical cancer cells. F-actin fluorescence staining were performed to investigate morphological change and Western blotting analyses were performed to determine epithelial mesenchymal transition-related marker expression and downstream signalling pathways.ResultsA total of 243 DEGs, including 55 upregulated and 188 downregulated DEGs, were found in CCa patients with LNM versus those without LNM. Among these, FABP4 was found to be closely associated with poor OS. Multivariate analysis uncovered that FABP4 was an independent risk factor for OS and LNM in patients with CCa. The immunohistochemical results verified dramatically increased FABP4 expression in CCa tissues compared to normal cervical epithelia and its association with poor OS and LNM. In vitro, The proliferation, migration and invasion of cervical cancer cells were significantly inhibited after knocking down of FABP4, which was accompanied by elevated expression of E-cadherin and downregulated expression of N-cadherin, Vimentin and p-AKT.ConclusionsFABP4 might be a promising biomarker of LNM and survival in patients with early-stage CCa and therefore could significantly contribute to the development of personalized prognosis prediction and therapy optimization.

In this study, we explored the risk factors for lymph node metastasis in patients with type II endometrial carcinoma (EC). Patients diagnosed with type II EC who underwent staged surgery and lymph node dissection were included. Univariate analysis was performed using a chi-square test for factors such as age, body mass index (BMI), menopausal status, histologic type, histologic grade, myometrial invasion, lymphatic vascular invasion (LVSI), tumor volume index, and para-aortic lymph node (PALN) or pelvic lymph node (PLN) metastasis. An analysis of multivariate factors was performed on the factors that were statistically significant in the univariate analysis. Pelvic lymph node metastasis was identified in 38 of the 184 patients with type II EC. Univariate analyses revealed that age ≥55 years, menopause, more than one-half myometrial invasion, and LVSI were risk factors for pelvic lymph node metastasis. Multivariate analysis indicated that myometrial invasion of more than one-half (hazard ratio (HR): 4.259) and LVSI (HR: 3.317) were independent risk factors for pelvic lymph node metastasis. Para-aortic lymph node metastasis was identified in 13 of the 184 patients with type II EC. Univariate analysis indicated that para-aortic lymph node metastasis was significantly associated with LVSI and pelvic lymph node metastases. Multivariate analysis suggested that pelvic lymph node metastasis (HR: 5.887) was an independent risk factor for para-aortic lymph node metastasis. LVSI and myometrial invasion depth >1/2 were significant predictors of pelvic lymph node metastasis in patients with type II EC. Patients with type II EC who have pelvic lymph node metastasis may be at risk of para-aortic lymph node metastasis.

Although risk factors for histologically overt lymph node metastasis in patients with early-stage colorectal cancer have been clarified, the risk factors for occult lymph node metastasis are not clear. This study was designed to clarify risk factors for lymph node metastasis, including occult metastasis, in patients with colorectal cancer invading the submucosa and to determine the criteria for endoscopic resection of early colorectal cancer. The risk factors for lymph node metastasis, including occult metastasis, were analyzed in 86 cases of surgically resected colorectal cancer invading the submucosa. The lymph nodes were assessed by immunohistochemistry with cytokeratin antibody CAM5.2. The frequencies of overt and occult metastasis to the lymph nodes were 13 percent (11/86) and 13 percent (10/75), respectively. Multivariate analysis showed vascular invasion (P = 0.001) and tumor budding (P = 0.003) to be independent risk factors for lymph node metastasis, including occult metastasis. For tumors with submucosal invasion < or =1,000 microm, no lymph node metastasis was found. The frequencies of lymph node metastasis for tumors with submucosal invasion of 1,000 to 2,000 microm and >2,000 microm were 21 and 37 percent, respectively. In considering combinations of risk factors, there was no lymph node metastasis in tumors having neither vascular invasion nor tumor budding and submucosal invasion of < or =3,000 microm. Vascular invasion, tumor budding, and the degree of submucosal invasion were significant risk factors for lymph node metastasis, including occult metastasis. These three factors can be used in combination to identify patients requiring additional surgery after endoscopic resection.

Multivariate analysis of potential risk factors for lymph node metastasis in patients with cutaneous squamous cell carcinoma of the head and neck

BackgroundPatients with T1 stage early colorectal cancer (CRC) can be treated with radical surgery or endoscopic surgery. Endoscopic surgery has a number of advantages, including minimal trauma and a rapid recovery. However, it cannot remove regional lymph nodes to assess whether there is lymph node metastasis. Thus, the analysis of the risk factors of lymph node metastasis in patients with T1 stage CRC is of great significance in the selection of appropriate treatment methods. Although previous studies have explored the risk factors for lymph node metastasis in T1 stage CRC patients, the number of cases were relatively insufficient, and further exploration is necessary.MethodsA total of 2,085 patients who had been pathologically diagnosed with CRC from 2015 to 2017 from the Surveillance, Epidemiology, and End Results (SEER) database. Among the patients, 324 had lymph node metastasis. A multivariate logistic regression analysis was conducted to analyze the risk factors of lymph node metastasis in patients with T1 stage CRC. Next, we established a prediction model to predict lymph node metastasis in patients with T1 stage CRC.ResultsThe results of the multivariate logistic regression analysis showed that age at diagnosis, rectosigmoid cancer, poorly differentiated or undifferentiated tumor cells, and distant metastasis were independent factors of lymph node metastasis in patients with T1 stage CRC (P<0.05). This study used the R4.0.3 statistical software for the statistical analysis. The data set was randomly divided into a training set and verification set. The training set comprised 1,460 patients, and the verification set comprised 625 patients. The area under the receiver operating characteristic curve (AUC) of the training set was 0.675 [95% confidence interval (CI): 0.635–0.714], and the AUC of the verification set was 0.682 (95% CI: 0.617–0.747). In the validation set, the model was tested by the Hosmer-Lemeshow Goodness-of-Fit Test (χ2=4.018, P=0.855), and the results showed that the model was reliable at predicting lymph node metastasis in patients with T1 stage CRC.ConclusionsFor CRC patients with high risk factors of lymph node metastasis, endoscopic physicians should carefully evaluate the advantages and disadvantages of the endoscopic surgery before deciding whether to perform this surgery.

Predictive Factors for Lymph Node Metastasis in Clinical Stage I Part-Solid Lung Adenocarcinoma

Lymphatic invasion as the solitary risk factor for extraperigastric lymph node metastasis in early gastric cancer.

AIMTo explore the features and prognostic value of lymph node metastasis in patients with T1-stage colorectal cancer (CRC).METHODSIn all, 321 cases of T1-stage CRC were selected from 10132 patients with CRC who received surgical therapy in six large-scale hospitals in China and were retrospectively analyzed. Univariate and multivariate analyses were performed to analyze the risk factors for lymphatic metastasis. A survival analysis was then performed to analyze the prognostic value of lymph node metastasis.RESULTSThe occurrence rate of T1 stage was 3.17% (321/10132); of these patients, the lymph node metastasis rate was 8.41% (27/321), and the non-lymph node metastasis rate was 91.59% (294/321). Univariate analysis showed that preoperative serum CEA, preoperative serum CA199, preoperative serum CA724, vascular invasion, and degree of differentiation were associated with lymph node metastasis in T1-stage CRC (P < 0.05 for all). Multivariate analysis indicated that preoperative serum CA724, vascular invasion, and degree of differentiation were closely related to lymph node metastasis (P < 0.05 for all). Log-rank survival analysis showed that age, preoperative serum CEA, preoperative serum CA199, vascular invasion, degree of differentiation, and lymph node metastasis (χ2 = 24.180, P < 0.001) were predictors of 5-year overall survival (OS) (P < 0.05 for all). COX regression analysis demonstrated that preoperative serum CA199 and lymph node metastasis (HR = 5.117; P < 0.05; 95%CI: 0.058-0.815) were independent prognostic indicators of 5-year OS in patients with T1-stage CRC (P < 0.05 for both).CONCLUSIONThe morbidity of T1-stage CRC was 3.17% for all CRC cases. Preoperative serum CA724, vascular invasion, and degree of differentiation are independent risk factors for lymph node metastasis. Lymph node metastasis is an independent prognostic factor for OS in patients with T1-stage CRC.

Papillary thyroid microcarcinoma (PTMC) measures 1 cm or less in its longest dimension. The incidence of PTMC is increasing worldwide. Surgery is the primary treatment; however, prophylactic central lymph node dissection is controversial, and discrepancies between different guidelines have been noted. Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis, while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients. To selectively perform prophylactic lymph node dissections in high-risk patients, it is important to identify predictive factors for lymph node metastases in patients with PTMC. Several studies have reported on this, but their conclusions are not entirely consistent. Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases, and the most commonly reported factors include age, gender, tumor size and location, multifocality, bilaterality, extrathyroidal extension, and abnormal lymph node found using ultrasound. Here, we provide an overview of previous studies along with a favorable opinion on or against these factors, with the aim of increasing the understanding of this topic among the medical community. In addition, current opinions about prophylactic central lymph node dissection are reviewed and discussed.

BACKGROUNDGastric cancer is the leading cause of cancer-related deaths worldwide. Early gastric cancer (EGC) is often associated with the risk of lymph node metastasis, which influences treatment decisions. Despite the use of enhanced computed tomography, the prediction of lymph node involvement remains challenging.AIMTo investigate the risk factors for lymph node metastasis and invasion depth in patients with EGC.METHODSIn total, 210 patients with pathologically diagnosed EGC were included in this study. Univariate and multivariate statistical analyses were used to predict risk factors for lymph node metastasis and invasion depth in patients with EGC.RESULTSAmong the 210 patients, 27 (12.9%) had lymph node metastases. Of the 117 patients with submucosal gastric cancer, 24 (20.5%) had lymph node metastases. Both univariate and multivariate analyses indicated that the depth of invasion in EGC was a risk factor for lymph node metastasis in these patients. Additionally, pathological type was identified as a risk factor for cancer cell invasion in patients with EGC.CONCLUSIONEGC invasion depth, not tumor type, size, age, sex, or location, predicts lymph node spread. Tumor type, not size, age, sex, or location, predicts cancer cell invasion.

Combined use of magnetic resonance imaging, CA 125 assay, histologic type, and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma

Aim:To determine the rate, repartition and risk factors of lymph node (LN) metastasis in patients with epithelial ovarian cancer. Methods: We reviewed retrospectively the pathological and clinical data of 184 patients with epithelial ovarian cancer at atertiary care center in Beirut, Lebanon. Results: 88% of patients received a pelvic and para-aortic lymphadenectomy. 70% of patients presentedLN metastases at both pelvic and para-aortic levels, while isolated pelvic or para-aortic LN metastases were seen in 16and 14% of cases, respectively. In a univariate analysis, the rate of positive LNs was higher in patients with serous histology (65vs33%;p<0.001), high-grade tumors (68vs26%;p<0.001), bilateral adnexal involvement (74vs27%;p<0.001), advanced clinical stage (p<0.001), interval debulking surgery (63.2vs36.8%;p=0.003) and positive peritoneal cytology (79vs26%;p<0.001). In a multivariate analysis, the rate of LN involvement was significantly higher in patients with higher grade, advanced clinical stage and positive peritoneal cytology. Conclusion: Serous histology, grade 3 tumors, positive peritoneal cytology, advanced clinical stage, interval surgery and bilateral adnexal involvement can predict LN metastasis in patients with epithelial ovarian cancer.

Objective:To explore the risk factors of lymph node metastasis and multiple lymph node metastasis in patients with stage CN0 papillary thyroid carcinoma. Methods:The clinical case data of 3 099 patients with CN0 papillary thyroid cancer who underwent lymph node dissection at Xijing Hospital of Air Force Medical University from January 2013 to December 2022 were retrospectively analyzed, univariate and multivariate logistic regression were used to analyze the risk factors of lymph node metastasis and multiple lymph node metastasis. Results:Male gender, age<55 years, multifocal lesions, and lesion size ≥2 cm were independent risk factors for lymph node metastasis in CN0 patients（P<0.05）, while diabetes was an independent protective factor for lymph node metastasis（P<0.05）.Age<55 years, capsular invasion, and multifocal lesions were independent risk factors for the presence of ≥3 lymph nodes with metastasis （P<0.05）. Conclusion:In CN0 stage PTC patients, special attention should be given to the possibility of lymph node metastasis when they are male, aged <55 years, have multifocal lesions, or have lesion size >2 cm.

Pelvic lymph node metastasis is a critical factor influencing prognosis and treatment strategies in cervical cancer patients. This study aimed to identify significant clinical and pathological risk factors associated with pelvic lymph node metastasis in patients with cervical cancer. We conducted a retrospective analysis of 186 cervical cancer patients treated at the Affiliated Hospital, Southwest Medical University from January 2010 to December 2020. Patients were divided into two groups: those with pelvic lymph node metastasis (n=40) and those without (n=146). Data on demographics, clinical characteristics, pathological features, and treatment modalities were collected. Statistical analysis included t-tests, chi-square tests, and logistic regression to evaluate potential risk factors for lymph node metastasis. Patients with pelvic lymph node metastasis were significantly older (mean age 52.5 ± 8.3 years) than those without metastasis (mean age 48.7 ± 10.2 years; p=0.023). High-risk HPV positivity was significantly associated with lymph node metastasis (75% vs. 41%, p=0.001). Lymphovascular invasion was observed in 75% of the metastatic group compared to 24.7% in the non-metastatic group (p<0.001). Tumor size >4 cm was more frequent in patients with metastasis (50% vs. 12.3%, p<0.001). Multivariate logistic regression analysis identified high-risk HPV infection (OR 4.13, 95% CI: 2.09-8.17, p<0.001), lymphovascular invasion (OR 7.87, 95% CI: 4.05-15.29, p<0.001), and tumor size >4 cm (OR 6.24, 95% CI: 3.24-12.02, p<0.001) as independent risk factors for pelvic lymph node metastasis. This study identifies several independent risk factors for pelvic lymph node metastasis in cervical cancer, including high-risk HPV infection, lymphovascular invasion, and tumor size greater than 4 cm. These findings can help guide clinical decision-making and individualized treatment planning, improving outcomes for patients with cervical cancer. Further prospective studies are warranted to validate these findings.